Organization
FAITH HARBOR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANGEL LYNNETTE LEE SCL, IPD (OWNER/EXECUTIVE DIRECTOR)
(270) 781-4050
Entity
Organization
Contact information
Practice address
1268 CAMPBELL LN STE 101, BOWLING GREEN, KY 42104-1034
(270) 781-4050
(270) 781-4099
Mailing address
PO BOX 151, ROCKFIELD, KY 42274-0151
(270) 781-4050
(270) 781-4099
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Enumeration date
10/19/2015
Last updated
10/19/2015
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