Organization
KENTUCKY ADDICTION CENTERS WEST 2, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TROUPER KRUEGER (CSO-HHR)
(979) 324-5456
Entity
Organization
Contact information
Practice address
148 STUART NELSON PARK RD, PADUCAH, KY 42001-9678
(270) 908-2681
Mailing address
148 STUART NELSON PARK RD, PADUCAH, KY 42001-9678
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
207QA0401X
Addiction Medicine (Family Medicine) Physician
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
03/24/2021
Last updated
03/24/2021
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