Healthcare Provider Details

I. General information

NPI: 1104097021
Provider Name (Legal Business Name): KMI ACQUISITION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2008
Last Update Date: 05/24/2024
Certification Date: 05/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8521 LAGRANGE RD
LOUISVILLE KY
40242-3800
US

IV. Provider business mailing address

8521 LAGRANGE RD
LOUISVILLE KY
40242-3800
US

V. Phone/Fax

Practice location:
  • Phone: 502-426-6380
  • Fax: 502-814-3711
Mailing address:
  • Phone: 502-426-6380
  • Fax: 502-814-3711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number100241
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number810229
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number100241
License Number StateKY

VIII. Authorized Official

Name: MR. STEVE FILTON
Title or Position: VICE PRESIDENT
Credential:
Phone: 610-768-3300