Healthcare Provider Details

I. General information

NPI: 1871317180
Provider Name (Legal Business Name): NEULIFE REHABILITATION OF KENTUCKY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2024
Last Update Date: 11/13/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 31W BYPASS
BOWLING GREEN KY
42101
US

IV. Provider business mailing address

189 ADAM SHEPHERD PARKWAY, SUITE 17 PMB #280
SHEPHERDSVILLE KY
40165
US

V. Phone/Fax

Practice location:
  • Phone: 844-936-5433
  • Fax:
Mailing address:
  • Phone: 844-936-5433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. PATRICK GLENN KELLEY
Title or Position: CEO
Credential:
Phone: 844-936-5433