Organization
INDEPENDENCE PLACE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIS DEITZ (EXECUTIVE DIRECTOR)
(270) 871-5617
Entity
Organization
Contact information
Practice address
2358 NICHOLASVILLE RD STE 180, LEXINGTON, KY 40503-3049
(859) 266-2807
(859) 335-0627
Mailing address
2358 NICHOLASVILLE RD STE 180, LEXINGTON, KY 40503-3049
(859) 266-2807
(859) 335-0627
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Enumeration date
05/01/2018
Last updated
05/01/2018
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