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General NPI Number Information
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NPI Number | 1821392135
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Entity Type | Organization
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Legal Business Name | THE METHODIST HOME OF KY
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Dates
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Enumeration Date | 12/29/2010
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Last Update Date | 04/26/2018
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Provider Practice Location Address
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Address Line | 1115 ASHGROVE ROAD
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City | NICHOLASVILLE
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State | KY
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Zip | 40356
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Country | US
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Telephone | 859-523-3001
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Fax | 859-241-3787
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Provider Business Mailing Address
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Address Line | PO BOX 930
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City | NICHOLASVILLE
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State | KY
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Zip | 40340-9800
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Country | US
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Telephone | 859-523-3001
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Fax | 859-241-3787
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Authorized Official
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Title or Position | VICE PRESIDENT OF PROGRAMS AND SERV
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Name | NICOLE LAVY-JOY
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Credential | LCSW
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Telephone | 859-523-4651
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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 | 500325
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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 | 500035
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number | 500035
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License Number State | KY
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 500035
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License Number State | KY
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