Provider Demographics
NPI:1932736477
Name:SOLID GROUND WELLNESS CENTERS, LLC
Entity Type:Organization
Organization Name:SOLID GROUND WELLNESS CENTERS, LLC
Other - Org Name:SOLID GROUND WELLNESS CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAUDILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-223-5119
Mailing Address - Street 1:PO BOX 630
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41702-0630
Mailing Address - Country:US
Mailing Address - Phone:606-373-4887
Mailing Address - Fax:
Practice Address - Street 1:14 LOGAN DR
Practice Address - Street 2:
Practice Address - City:JEFF
Practice Address - State:KY
Practice Address - Zip Code:41751-9038
Practice Address - Country:US
Practice Address - Phone:606-487-0351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-25
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100671360Medicaid