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NPI Code Detail

MEDICARE: FATHER MALONEY'S BOYS' HAVEN, INC.

MEDICARE: FATHER MALONEY'S BOYS' HAVEN, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist
2251B00000XCase Management AgencyKY
3253J00000XFoster Care Agency500449KY
4322D00000XEmotionally Disturbed Childrens' Residential Treatment Facility500006KY
5251S00000XCommunity/Behavioral Health AgencyKY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1841566387
Entity Type Code : Organization
Provider Name (Legal Business Name) : FATHER MALONEY'S BOYS' HAVEN, INC.
Provider Business Mailing Address
First Line : 2301 GOLDSMITH LANE
Second Line :
City : LOUISVILLE
State : KY
Zip : 40218-1018
Country : US
Telephone Number : 502-458-1171
Fax Number : 502-451-2161
Provider Business Practice Location Address
First Line : 2301 GOLDSMITH LANE
Second Line :
City : LOUISVILLE
State : KY
Zip : 40218-1018
Country : US
Telephone Number : 502-458-1171
Fax Number : 502-451-2161
Authorized Official
Title or Position : PROGRAM DIRECTOR
Name : MR. JOSH ERIC SWETNAM
Credential : LCSW
Telephone Number : 502-458-1171
Provider Enumeration Date : 03/29/2012
Last Update Date : 12/05/2023

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