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Organization
LAKE CUMBERLAND REG MHMR BOARD EPSDT
Active
Organization
LAKE CUMBERLAND REG MHMR BOARD EPSDT
Active
Other names
Adanta Group EPSDT
Organization subpart
No
Provider details
NPI number
Authorized official
JACK LEWIS (HR DIRECTOR)
(606) 679-4782
Entity
Organization
Contact information
Practice address
130 SOUTHERN SCHOOL RD, SOMERSET, KY 42501-3223
(606) 679-4782
(606) 678-5296
Mailing address
130 SOUTHERN SCHOOL RD, SOMERSET, KY 42501-3223
(606) 679-4782
(606) 678-5296
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
261QR0400X
Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
02/28/2007
Last updated
12/26/2013
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