MEDICARE: RESURRECTION TREATMENT CLINICS LLC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	207RA0401X	Addiction Medicine (Internal Medicine) Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548633415
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESURRECTION TREATMENT CLINICS LLC

Provider Business Mailing Address
First Line	:	7145 E VIRGINIA ST STE 2000
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47715-9147
Country	:	US
Telephone Number	:	812-962-7894
Fax Number	:

Provider Business Practice Location Address
First Line	:	1718 ALEXANDRIA DR
Second Line	:	SUITE 101
City	:	LEXINGTON
State	:	KY
Zip	:	40504-3144
Country	:	US
Telephone Number	:	859-983-0678
Fax Number	:	859-263-1312

Authorized Official
Title or Position	:	OWNER
Name	:	LAWRENCE YORK
Credential	:
Telephone Number	:	859-276-1015

Provider Enumeration Date	:	11/02/2015
Last Update Date	:	10/09/2024

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