Provider Demographics
NPI:1356665137
Name:SOLACE CASE MANAGEMENT
Entity type:Organization
Organization Name:SOLACE CASE MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:COUCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-216-5080
Mailing Address - Street 1:PO BOX 286
Mailing Address - Street 2:
Mailing Address - City:JEFF
Mailing Address - State:KY
Mailing Address - Zip Code:41751-0286
Mailing Address - Country:US
Mailing Address - Phone:606-476-9572
Mailing Address - Fax:
Practice Address - Street 1:130 MAIN ST
Practice Address - Street 2:
Practice Address - City:VICCO
Practice Address - State:KY
Practice Address - Zip Code:41773
Practice Address - Country:US
Practice Address - Phone:606-476-9572
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health