1841566387 NPI number — FATHER MALONEY'S BOYS' HAVEN, INC.

Table of content: (NPI 1841566387)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841566387 NPI number — FATHER MALONEY'S BOYS' HAVEN, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FATHER MALONEY'S BOYS' HAVEN, INC.
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:
BOYS AND GIRLS HAVEN
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:
1841566387
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2301 GOLDSMITH LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40218-1018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-458-1171
Provider Business Mailing Address Fax Number:
502-451-2161

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2301 GOLDSMITH LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40218-1018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-458-1171
Provider Business Practice Location Address Fax Number:
502-451-2161
Provider Enumeration Date:
03/29/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SWETNAM
Authorized Official First Name:
JOSH
Authorized Official Middle Name:
ERIC
Authorized Official Title or Position:
PROGRAM DIRECTOR
Authorized Official Telephone Number:
502-458-1171

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251B00000X , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 253J00000X , with the licence number: 500449 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 322D00000X , with the licence number: 500006 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 7100272600 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 29100229 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 29200227 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".