Healthcare Provider Details

I. General information

NPI: 1811029176
Provider Name (Legal Business Name): PRESBYTERIAN CHILD WELFARE AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 08/13/2021
Certification Date: 07/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 BUCKHORN LN
BUCKHORN KY
41721-8987
US

IV. Provider business mailing address

116 BUCKHORN LN
BUCKHORN KY
41721-8987
US

V. Phone/Fax

Practice location:
  • Phone: 606-398-7000
  • Fax: 606-398-7912
Mailing address:
  • Phone: 606-398-7000
  • Fax: 606-398-7912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number552
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number097123960(1)
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number097122583(2)
License Number StateKY
# 5
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MITCH SMITH
Title or Position: CFO
Credential:
Phone: 606-398-7000