1568808640 NPI number — BHG XXIV, LLC

Table of content: (NPI 1568808640)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568808640 NPI number — BHG XXIV, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BHG XXIV, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BHG PAINTSVILLE TREATMENT CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568808640
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5001 SPRING VALLEY RD STE 600E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75244-8217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-365-6100
Provider Business Mailing Address Fax Number:
214-365-6150

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
628 JEFFERSON AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PAINTSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-789-6966
Provider Business Practice Location Address Fax Number:
606-789-7466
Provider Enumeration Date:
05/16/2013

Additional Information

Authorized Official

Authorized Official Last Name:
GASAWAY
Authorized Official First Name:
JEMECE
Authorized Official Middle Name:
MICHELLE
Authorized Official Title or Position:
DIRECTOR OF LICENSING
Authorized Official Telephone Number:
214-365-6126

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , with the licence number:  800197 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM2800X , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0405X , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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