Basic Information
| Provider Information | |||||||||
| NPI: | 1386067254 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BHG XXXV, LLC | ||||||||
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| OtherOrganizationName: | BHG LEXINGTON TREATMENT CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5001 SPRING VALLEY RD | ||||||||
| Address2: | SUITE 600 EAST | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752443946 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143646100 | ||||||||
| FaxNumber: | 2143656150 | ||||||||
| Practice Location | |||||||||
| Address1: | 455 PARK PL | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405111830 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592760533 | ||||||||
| FaxNumber: | 8592773653 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2014 | ||||||||
| LastUpdateDate: | 04/24/2020 | ||||||||
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| AuthorizedOfficialLastName: | GASAWAY | ||||||||
| AuthorizedOfficialFirstName: | JEMECE | ||||||||
| AuthorizedOfficialMiddleName: | MICHELLE | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF LICENSING | ||||||||
| AuthorizedOfficialTelephone: | 2143656126 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MSW, LMSW | ||||||||
| NPICertificationDate: | 04/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | 800197 | KY | N | Agencies | Case Management | 261QM0801X | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 261QM2800X | KY | N | Ambulatory Health Care Facilities | Clinic/Center | Methadone Clinic | 261QR0405X | KY | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
No ID Information.