MEDICARE: ISAIAH HOUSE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223D0001X	Public Health Dentistry
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1215793112
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ISAIAH HOUSE INC

Provider Business Mailing Address
First Line	:	PO BOX 188
Second Line	:
City	:	WILLISBURG
State	:	KY
Zip	:	40078-0188
Country	:	US
Telephone Number	:	859-375-9200
Fax Number	:	859-375-9202

Provider Business Practice Location Address
First Line	:	535 W SECOND ST STE 300
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40508-1268
Country	:	US
Telephone Number	:	859-375-9200
Fax Number	:

Authorized Official
Title or Position	:	VP
Name	:	LUCILLE KOEHL
Credential	:
Telephone Number	:	317-755-7433

Provider Enumeration Date	:	02/27/2024
Last Update Date	:	02/16/2026

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Directions to “ISAIAH HOUSE INC ” Practice Location

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