NPIMap

Organization Active NPI

Ethan Health LLC

  • Substance Abuse Rehabilitation Facility
  • Richmond, KY
National Provider Identifier
1962851584
Registry record updated Jul 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
Legal business name
ETHAN HEALTH LLC
Practice address
1623 Foxhaven Dr
Richmond, KY 40475-1056
Phone
(859) 317-8714
NPI assigned
Jun 4, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ashley Fenn
Title
Cfo
Phone
(859) 317-9714

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Addiction Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QA0401X
Substance Abuse Rehabilitation Facility 324500000X Primary

Addresses

Primary practice location

1623 Foxhaven Dr
Richmond, KY 40475-1056

Mailing address

1623 Foxhaven Dr
Richmond, KY 40475-1056

Other practice location 1

6159 1st Financial Dr Ste 100
Burlington, KY 41005-7892
Phone (859) 625-5235

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160913001887 KY Part B Supplier - Clinic/Group Practice 4183910474 Receives reassigned benefits from 6 practitioners
Practice locations: Richmond, KY

National Provider Directory

National Provider Directory
Tax ID family
Ethan Health4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

6159 1st Financial Dr
Ste 100
Burlington, KY 41005
Phone (859) 625-5235

2444 Harrodsburg Rd
Lexington, KY 40503
Phone (859) 258-6950

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1464998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722384000000",
    "number": "1962851584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1623 FOXHAVEN DR",
            "city": "RICHMOND",
            "state": "KY",
            "postal_code": "404751056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1623 FOXHAVEN DR",
            "city": "RICHMOND",
            "state": "KY",
            "postal_code": "404751056",
            "telephone_number": "859-317-8714"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6159 1st Financial Dr Ste 100",
            "address_purpose": "LOCATION",
            "city": "Burlington",
            "state": "KY",
            "postal_code": "410057892",
            "country_code": "US",
            "telephone_number": "859-625-5235",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ETHAN HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-04",
        "last_updated": "2024-07-31",
        "certification_date": "2024-07-31",
        "status": "A",
        "authorized_official_last_name": "FENN",
        "authorized_official_first_name": "ASHLEY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "859-317-9714"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QA0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Richmond, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.