Healthcare Provider Details

I. General information

NPI: 1821392135
Provider Name (Legal Business Name): THE METHODIST HOME OF KY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2010
Last Update Date: 04/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 ASHGROVE ROAD
NICHOLASVILLE KY
40356
US

IV. Provider business mailing address

PO BOX 930
NICHOLASVILLE KY
40340-9800
US

V. Phone/Fax

Practice location:
  • Phone: 859-523-3001
  • Fax: 859-241-3787
Mailing address:
  • Phone: 859-523-3001
  • Fax: 859-241-3787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number500325
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number500035
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number500035
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number500035
License Number StateKY

VIII. Authorized Official

Name: NICOLE LAVY-JOY
Title or Position: VICE PRESIDENT OF PROGRAMS AND SERV
Credential: LCSW
Phone: 859-523-4651