1811029176 NPI number — PRESBYTERIAN CHILD WELFARE AGENCY

Table of content: (NPI 1811029176)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811029176 NPI number — PRESBYTERIAN CHILD WELFARE AGENCY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRESBYTERIAN CHILD WELFARE AGENCY
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:
BUCKHORN CHILDREN AND FAMILY SERVICES
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:
1811029176
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/13/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
116 BUCKHORN LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUCKHORN
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41721-8987
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-398-7000
Provider Business Mailing Address Fax Number:
606-398-7912

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
116 BUCKHORN LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUCKHORN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41721-8987
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-398-7000
Provider Business Practice Location Address Fax Number:
606-398-7912
Provider Enumeration Date:
03/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
MITCH
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
606-398-7000

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , with the licence number:  552 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 322D00000X , with the licence number: 097123960(1) , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 323P00000X , with the licence number: 097122583(2) , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 7100258860 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100258880 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 810858 . This is a "KY OIG - OUTPATIENT AODE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 810859 . This is a "KY OIG - OUTPATIENT AODE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 04097010 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 12394 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 04097028 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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