Provider Demographics
NPI:1598159378
Name:STEPWORKS OF LONDON LLC
Entity Type:Organization
Organization Name:STEPWORKS OF LONDON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:G
Authorized Official - Last Name:INGRAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-545-9031
Mailing Address - Street 1:PO BOX 6209
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42702-6209
Mailing Address - Country:US
Mailing Address - Phone:800-545-9031
Mailing Address - Fax:606-877-9996
Practice Address - Street 1:3825 MARYDELL RD
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-8633
Practice Address - Country:US
Practice Address - Phone:800-545-9031
Practice Address - Fax:606-877-9996
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEPWORKS RECOVERY CENTERS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-19
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder