MEDICARE: CENTER FOR BEHAVIORAL HEALTH KENTUCKY LLC

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
1	261QM2800X	Methadone Clinic

General Provider Information

NPI Number	:	1871027854
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR BEHAVIORAL HEALTH KENTUCKY LLC

Provider Business Mailing Address
First Line	:	5001 SPRING VALLEY ROAD
Second Line	:	SUITE 600 EAST
City	:	DALLAS
State	:	TX
Zip	:	75244-3946
Country	:	US
Telephone Number	:	214-365-6100
Fax Number	:	214-365-6150

Provider Business Practice Location Address
First Line	:	1402A BROWNS LN
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-4609
Country	:	US
Telephone Number	:	502-894-0234
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JAY HIGHAM
Credential	:
Telephone Number	:	214-365-6112

Provider Enumeration Date	:	04/17/2017
Last Update Date	:	12/26/2024

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