Healthcare Provider Details

I. General information

NPI: 1730595638
Provider Name (Legal Business Name): THE KY UNITED METHODIST HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2014
Last Update Date: 07/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 PHILLIPS CT
OWENSBORO KY
42303-3772
US

IV. Provider business mailing address

201 PHILLIPS CT
OWENSBORO KY
42303-3772
US

V. Phone/Fax

Practice location:
  • Phone: 270-683-6481
  • Fax: 270-926-0817
Mailing address:
  • Phone: 270-683-6481
  • Fax: 270-926-0817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number600148
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number600161
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number600148
License Number StateKY

VIII. Authorized Official

Name: MS. CARLA BARR
Title or Position: CAMPUS DIRECTOR
Credential: MA
Phone: 270-683-6481