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General NPI Number Information
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NPI Number | 1851435705
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Entity Type | Organization
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Legal Business Name | BELLEWOOD PRESBYTERIAN HOME FOR CHILDREN
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 11103 PARK RD
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City | LOUISVILLE
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State | KY
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Zip | 40223-2424
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Country | US
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Telephone | 502-245-4171
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Fax | 502-245-7447
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Provider Business Mailing Address
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Address Line | PO BOX 23309
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City | LOUISVILLE
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State | KY
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Zip | 40223-0309
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Country | US
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Telephone | 502-245-4171
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Fax | 502-245-7447
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. JERRY L CANTRELL
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Credential | LMFT
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Telephone | 502-245-4171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 |
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License Number State | KY
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