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General NPI Number Information
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NPI Number | 1891442141
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Entity Type | Organization
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Legal Business Name | RESILIENT THERAPY SERVICES, LLC
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Dates
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Enumeration Date | 03/07/2022
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Last Update Date | 03/07/2022
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Provider Practice Location Address
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Address Line | 1512 W HIGHWAY 42
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City | LA GRANGE
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State | KY
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Zip | 40031-9554
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Country | US
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Telephone | 512-826-1243
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Fax |
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Provider Business Mailing Address
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Address Line | 11500 VALLEY VIEW RD
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City | LOUISVILLE
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State | KY
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Zip | 40223-1353
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Country | US
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Telephone | 512-826-1243
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | ERIC MAKOWSKI
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Credential |
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Telephone | 512-826-1243
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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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 | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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