Basic Information
| Provider Information | |||||||||
| NPI: | 1871027854 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CENTER FOR BEHAVIORAL HEALTH KENTUCKY, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 897 | ||||||||
| Address2: | |||||||||
| City: | BOISE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 837010897 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083679446 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1402A BROWNS LN | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402074609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028940234 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2017 | ||||||||
| LastUpdateDate: | 04/17/2017 | ||||||||
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| AuthorizedOfficialLastName: | MASSMAN | ||||||||
| AuthorizedOfficialFirstName: | BRANT | ||||||||
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| AuthorizedOfficialTitleorPosition: | SEC/TREAS. | ||||||||
| AuthorizedOfficialTelephone: | 2083679446 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM2800X | Y | Ambulatory Health Care Facilities | Clinic/Center | Methadone Clinic |
No ID Information.