Organization
2ND CHANCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBORAH FARMER (MGR)
(859) 368-8820
Entity
Organization
Contact information
Practice address
1420 N BROADWAY, LEXINGTON, KY 40505-3155
(859) 368-9874
(859) 368-8822
Mailing address
1420 N BROADWAY, LEXINGTON, KY 40505-3155
(859) 368-8820
(859) 368-8822
Taxonomy
Speciality
Code
Description
License number
State
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100338550
—
KY
Enumeration date
05/13/2014
Last updated
05/03/2019
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