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General NPI Number Information
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NPI Number | 1649258781
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Entity Type | Organization
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Legal Business Name | TEN BROECK DUPONT INC
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Dates
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Enumeration Date | 01/09/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 1405 BROWNS LN
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City | LOUISVILLE
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State | KY
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Zip | 40207-4608
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Country | US
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Telephone | 502-896-0495
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Fax | 502-893-8792
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Provider Business Mailing Address
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Address Line | 1405 BROWNS LN
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City | LOUISVILLE
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State | KY
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Zip | 40207-4608
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Country | US
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Telephone | 502-896-0495
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Fax | 502-893-8792
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. JOHN HOLLINSWORTH
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Credential |
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Telephone | 502-896-0495
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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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 | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number | 100595
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License Number State | KY
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