Healthcare Provider Details

I. General information

NPI: 1417036575
Provider Name (Legal Business Name): REGIONAL CHILD DEVELOPMENT CLINICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SCOTTSVILLE RD SUITE 100
BOWLING GREEN KY
42104-3217
US

IV. Provider business mailing address

1600 SCOTTSVILLE RD SUITE 100
BOWLING GREEN KY
42104-3217
US

V. Phone/Fax

Practice location:
  • Phone: 270-843-8284
  • Fax: 270-843-8362
Mailing address:
  • Phone: 270-843-8284
  • Fax: 270-843-8362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number3209
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number1002
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number3128
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number1044
License Number StateKY
# 5
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number1072556
License Number StateKY

VIII. Authorized Official

Name: MRS. BETSY MARIE KITCHENS
Title or Position: EXECUTIVE DIRECTOR
Credential: RN,C
Phone: 270-843-8284