Provider Demographics
NPI:1396027058
Name:BIG POPS PLACE INC.
Entity Type:Organization
Organization Name:BIG POPS PLACE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:M
Authorized Official - Last Name:HALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-434-1825
Mailing Address - Street 1:PO BOX 1287
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:KY
Mailing Address - Zip Code:41649-1287
Mailing Address - Country:US
Mailing Address - Phone:606-434-1825
Mailing Address - Fax:606-478-6674
Practice Address - Street 1:3714 CANEY FORK RD
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:KY
Practice Address - Zip Code:41649-7830
Practice Address - Country:US
Practice Address - Phone:606-434-1825
Practice Address - Fax:606-478-6674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care