Provider Demographics
NPI:1386230639
Name:GALENA LLC
Entity Type:Organization
Organization Name:GALENA LLC
Other - Org Name:GALENA LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PHOENIX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-801-0399
Mailing Address - Street 1:543 N WILSON RD STE D
Mailing Address - Street 2:
Mailing Address - City:RADCLIFF
Mailing Address - State:KY
Mailing Address - Zip Code:40160-2134
Mailing Address - Country:US
Mailing Address - Phone:270-801-0399
Mailing Address - Fax:
Practice Address - Street 1:543 N WILSON RD STE D
Practice Address - Street 2:
Practice Address - City:RADCLIFF
Practice Address - State:KY
Practice Address - Zip Code:40160-2134
Practice Address - Country:US
Practice Address - Phone:270-801-0399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-21
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty