Organization
ADVOCACY & SUPPORT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LISA J SAMPSON (EXECUTIVE DIRECTOR)
(270) 234-9236
Entity
Organization
Contact information
Practice address
890 RINEYVILLE RD, ELIZABETHTOWN, KY 42701-8927
(270) 234-9236
Mailing address
890 RINEYVILLE RD, ELIZABETHTOWN, KY 42701-8927
(270) 234-9236
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13000146
SPEC CHILDREN SERV
KY
Enumeration date
12/20/2006
Last updated
08/22/2020
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