Healthcare Provider Details

I. General information

NPI: 1740554864
Provider Name (Legal Business Name): USPIRITUS-BROOKLAWN-STEIL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2012
Last Update Date: 11/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 BROOKLAWN CAMPUS DR
LOUISVILLE KY
40218
US

IV. Provider business mailing address

3121 BROOKLAWN CAMPUS DR
LOUISVILLE KY
40218-1282
US

V. Phone/Fax

Practice location:
  • Phone: 502-451-5177
  • Fax: 502-451-0896
Mailing address:
  • Phone: 502-451-5177
  • Fax: 502-451-0896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number StateKY

VIII. Authorized Official

Name: MARY KATE O'LEARY
Title or Position: PRESIDENT, CEO
Credential:
Phone: 502-451-5177