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General NPI Number Information
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NPI Number | 1730595638
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Entity Type | Organization
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Legal Business Name | THE KY UNITED METHODIST HOME
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Dates
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Enumeration Date | 07/11/2014
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Last Update Date | 07/11/2014
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Provider Practice Location Address
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Address Line | 201 PHILLIPS CT
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City | OWENSBORO
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State | KY
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Zip | 42303-3772
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Country | US
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Telephone | 270-683-6481
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Fax | 270-926-0817
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Provider Business Mailing Address
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Address Line | 201 PHILLIPS CT
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City | OWENSBORO
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State | KY
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Zip | 42303-3772
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Country | US
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Telephone | 270-683-6481
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Fax | 270-926-0817
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Authorized Official
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Title or Position | CAMPUS DIRECTOR
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Name | MS. CARLA BARR
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Credential | MA
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Telephone | 270-683-6481
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 600161
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | 600148
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 600148
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License Number State | KY
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