=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063853620
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAMILY & CHILDREN'S FIRST, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2013
-----------------------------------------------------
Last Update Date | 10/25/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 W COURT AVE SUITE 102
-----------------------------------------------------
City | JEFFERSONVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47130-3502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-893-3900
-----------------------------------------------------
Fax | 502-893-9646
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 525 ZANE ST
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40203-3203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-893-3900
-----------------------------------------------------
Fax | 502-893-9646
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT - FINANCE
-----------------------------------------------------
Name | MR. JACK MCQUADE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 502-893-3900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 06-0009
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------