Healthcare Provider Details

I. General information

NPI: 1851435705
Provider Name (Legal Business Name): BELLEWOOD PRESBYTERIAN HOME FOR CHILDREN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11103 PARK RD
LOUISVILLE KY
40223-2424
US

IV. Provider business mailing address

PO BOX 23309
LOUISVILLE KY
40223-0309
US

V. Phone/Fax

Practice location:
  • Phone: 502-245-4171
  • Fax: 502-245-7447
Mailing address:
  • Phone: 502-245-4171
  • Fax: 502-245-7447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. JERRY L CANTRELL
Title or Position: EXECUTIVE DIRECTOR
Credential: LMFT
Phone: 502-245-4171