| Unbound Life Llc | |
|
100 Par Ln Ste 102 Elizabethtown KY 42701-9059 | |
| (270) 506-3385 | |
| Not Available |
| Full Name | Unbound Life Llc |
|---|---|
| Speciality | Substance Abuse Rehabilitation Facility |
| Location | 100 Par Ln Ste 102, Elizabethtown, Kentucky |
| Authorized Official Name and Position | Cameron Vance (ADMINISTRATOR) |
| Authorized Official Contact | 2703202605 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Unbound Life Llc 100 Par Ln Ste 102 Elizabethtown KY 42701-9059 Ph: () - | Unbound Life Llc 100 Par Ln Ste 102 Elizabethtown KY 42701-9059 Ph: (270) 506-3385 |
| NPI Number | 1194456962 |
|---|---|
| Provider Enumeration Date | 06/22/2022 |
| Last Update Date | 01/10/2023 |
| Certification Date | 01/10/2023 |
| Medicare PECOS PAC ID | 5193198448 |
|---|---|
| Medicare Enrollment ID | O20230307001621 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194456962 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
| 324500000X | Substance Abuse Rehabilitation Facility | (* (Not Available)) | Primary |
| Provider Name | Dianne Bradley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1750666152 PECOS PAC ID: 5991925372 Enrollment ID: I20230307001711 |
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