Organization
LAKE CUMBERLAND RECOVERY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MIKKLE LEE HAMPTON (PRESIDENT)
(606) 516-9939
Entity
Organization
Contact information
Practice address
8294 S HIGHWAY 27, BURNSIDE, KY 42519-9412
(606) 516-9939
Mailing address
505 WONDERING WOODS, SOMERSET, KY 42053
(606) 516-9939
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
11/19/2019
Last updated
12/10/2021
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