| Ethan Health Llc | |
|
1623 Foxhaven Dr Richmond KY 40475-1056 | |
| (859) 317-8714 | |
| Not Available |
| Full Name | Ethan Health Llc |
|---|---|
| Speciality | Substance Abuse Rehabilitation Facility |
| Location | 1623 Foxhaven Dr, Richmond, Kentucky |
| Authorized Official Name and Position | Ashley Fenn (CFO) |
| Authorized Official Contact | 8593179714 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ethan Health Llc 1623 Foxhaven Dr Richmond KY 40475-1056 Ph: () - | Ethan Health Llc 1623 Foxhaven Dr Richmond KY 40475-1056 Ph: (859) 317-8714 |
| NPI Number | 1962851584 |
|---|---|
| Provider Enumeration Date | 06/04/2016 |
| Last Update Date | 04/19/2023 |
| Certification Date | 04/19/2023 |
| Medicare PECOS PAC ID | 4183910474 |
|---|---|
| Medicare Enrollment ID | O20160913001887 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962851584 | NPI | - | NPPES |
| Provider Name | Teresa Parrott |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1497958771 PECOS PAC ID: 4385625672 Enrollment ID: I20040524001484 |
| Provider Name | Stuart Martin |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1093707564 PECOS PAC ID: 0446232433 Enrollment ID: I20051202000072 |
| Provider Name | William R Crowe |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1750387239 PECOS PAC ID: 3476567629 Enrollment ID: I20060126001021 |
| Provider Name | Heather J Mcclure |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871968271 PECOS PAC ID: 4789979287 Enrollment ID: I20160823002012 |
| Provider Name | Tina Holbrook |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902350556 PECOS PAC ID: 0042598245 Enrollment ID: I20161021001960 |
| Provider Name | Stacy Harris |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1457401374 PECOS PAC ID: 8022394634 Enrollment ID: I20170414000387 |
| Provider Name | Gulena Yvonne Reffett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144871138 PECOS PAC ID: 2365876299 Enrollment ID: I20191230002192 |
| Provider Name | Karen Cole |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386300085 PECOS PAC ID: 2668854647 Enrollment ID: I20220808002262 |
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