Healthcare Provider Details

I. General information

NPI: 1871725572
Provider Name (Legal Business Name): PATIENT CARE BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2009
Last Update Date: 08/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1290 SILAS DEANE HWY SUITE 3B
WETHERSFIELD CT
06109-4337
US

IV. Provider business mailing address

9510 ORMSBY STATION RD SUITE 300
LOUISVILLE KY
40223-4081
US

V. Phone/Fax

Practice location:
  • Phone: 860-257-1887
  • Fax: 860-257-1858
Mailing address:
  • Phone: 502-891-1000
  • Fax: 502-891-8064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. PATRICK T. LYLES
Title or Position: SR. VP, ADMINISTRATION
Credential:
Phone: 502-891-1044