Provider Demographics
NPI:1619381159
Name:MOMENTUM RECOVERY CENTER, PLLC
Entity Type:Organization
Organization Name:MOMENTUM RECOVERY CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KRONENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-868-7272
Mailing Address - Street 1:100 EASTSIDE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-9797
Mailing Address - Country:US
Mailing Address - Phone:502-868-7272
Mailing Address - Fax:502-868-7273
Practice Address - Street 1:100 EASTSIDE DR
Practice Address - Street 2:SUITE B
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-9797
Practice Address - Country:US
Practice Address - Phone:502-868-7272
Practice Address - Fax:502-868-7273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-12
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder