Healthcare Provider Details

I. General information

NPI: 1487936449
Provider Name (Legal Business Name): FLORENCE CRITTENTON HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2011
Last Update Date: 09/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 W FOURTH ST
LEXINGTON KY
40508-1205
US

IV. Provider business mailing address

519 W FOURTH ST
LEXINGTON KY
40508-1205
US

V. Phone/Fax

Practice location:
  • Phone: 859-252-8636
  • Fax: 859-252-5546
Mailing address:
  • Phone: 859-252-8636
  • Fax: 859-252-5546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number500066
License Number StateKY

VIII. Authorized Official

Name: MS. JENNIFER CONNOR
Title or Position: THERAPIST/PROGRAM DIRECTOR
Credential: LCSW
Phone: 859-252-8636