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NPI Code Detail

MEDICARE: ADDIXXION RECOVERY OF KENTUCKY, LLC

MEDICARE: ADDIXXION RECOVERY OF KENTUCKY, 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
1207QA0401XAddiction Medicine (Family Medicine) Physician

General Provider Information

NPI Number : 1952706111
Entity Type Code : Organization
Provider Name (Legal Business Name) : ADDIXXION RECOVERY OF KENTUCKY, LLC
Provider Business Mailing Address
First Line : 461 S 4TH ST
Second Line :
City : DANVILLE
State : KY
Zip : 40422-2053
Country : US
Telephone Number : 859-209-2305
Fax Number :
Provider Business Practice Location Address
First Line : 106 BELINDA BLVD
Second Line :
City : DANVILLE
State : KY
Zip : 40422-3217
Country : US
Telephone Number : 859-209-2320
Fax Number :
Authorized Official
Title or Position : MARKETING
Name : MRS. GINGER JACKSON
Credential :
Telephone Number : 859-333-5125
Provider Enumeration Date : 10/30/2014
Last Update Date : 10/30/2014

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