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General NPI Number Information
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NPI Number | 1952050197
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Entity Type | Organization
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Legal Business Name | MEDELLA HOUSE
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Dates
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Enumeration Date | 03/23/2022
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Last Update Date | 10/23/2023
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Provider Practice Location Address
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Address Line | 321 RIDGE RD
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City | CHARLESTOWN
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State | IN
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Zip | 47111-2033
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Country | US
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Telephone | 502-235-5437
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Fax |
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Provider Business Mailing Address
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Address Line | 321 RIDGE RD
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City | CHARLESTOWN
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State | IN
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Zip | 47111-2033
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Country | US
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Telephone | 502-235-5437
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | COURTNEY TUTT
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Credential | NURSE PRACTITIONER
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Telephone | 502-235-5437
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0800X
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Taxonomy Name | Recovery Care Clinic/Center
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License Number |
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License Number State |
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