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General NPI Number Information
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NPI Number | 1457952012
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Entity Type | Organization
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Legal Business Name | KENTUCKY RECOVERY LIMITED LIABILITY COMPANY
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Dates
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Enumeration Date | 11/02/2020
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Last Update Date | 11/02/2020
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Provider Practice Location Address
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Address Line | 5115 S 3RD ST
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City | LOUISVILLE
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State | KY
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Zip | 40214-2601
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Country | US
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Telephone | 502-690-1511
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Fax |
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Provider Business Mailing Address
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Address Line | 5115 S 3RD ST
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City | LOUISVILLE
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State | KY
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Zip | 40214-2601
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Country | US
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Telephone | 502-690-1511
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JOSEPH NALLEY
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Credential |
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Telephone | 502-690-1511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083A0300X
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Taxonomy Name | Addiction Medicine (Preventive Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number |
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License Number State |
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