Healthcare Provider Details

I. General information

NPI: 1699710798
Provider Name (Legal Business Name): CAMPBELL LODGE BOYS' HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5161 SKYLINE DR
HIGHLAND HEIGHTS KY
41076-3545
US

IV. Provider business mailing address

5161 SKYLINE DR
HIGHLAND HEIGHTS KY
41076-3545
US

V. Phone/Fax

Practice location:
  • Phone: 859-781-1214
  • Fax: 859-442-3473
Mailing address:
  • Phone: 859-781-1214
  • Fax: 859-442-3473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL L SCHROTH
Title or Position: EXECUTIVE DIRECTOR
Credential: MSW
Phone: 859-781-1214