Provider Demographics
NPI:1356844039
Name:ISAIAH HOUSE, INC
Entity Type:Organization
Organization Name:ISAIAH HOUSE, INC
Other - Org Name:JAKE KEURTZ CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SYDNEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:AYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-375-9200
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:WILLISBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40078-0188
Mailing Address - Country:US
Mailing Address - Phone:859-375-9200
Mailing Address - Fax:859-375-9202
Practice Address - Street 1:100 BROADWAY ST STE 102
Practice Address - Street 2:
Practice Address - City:CHAPLIN
Practice Address - State:KY
Practice Address - Zip Code:40012-8087
Practice Address - Country:US
Practice Address - Phone:859-375-9200
Practice Address - Fax:859-375-9202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-09
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility