Provider Demographics
NPI:1871013326
Name:SUGAR CAMP HOUSE ADULT DAY HEALTH CARE
Entity Type:Organization
Organization Name:SUGAR CAMP HOUSE ADULT DAY HEALTH CARE
Other - Org Name:SUGAR CAMP HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:NEELEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-593-6405
Mailing Address - Street 1:157 KY HWY 3346
Mailing Address - Street 2:
Mailing Address - City:BOONEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41314
Mailing Address - Country:US
Mailing Address - Phone:606-593-7240
Mailing Address - Fax:
Practice Address - Street 1:157 KY HWY 3346
Practice Address - Street 2:
Practice Address - City:BOONEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41314-4131
Practice Address - Country:US
Practice Address - Phone:606-593-6405
Practice Address - Fax:606-593-7240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-26
Last Update Date:2017-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY750198261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care