Provider Demographics
NPI:1033275342
Name:USPIRITUS-BROOKLAWN-HORIZONS
Entity Type:Organization
Organization Name:USPIRITUS-BROOKLAWN-HORIZONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:KATE
Authorized Official - Last Name:O'LEARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-451-5177
Mailing Address - Street 1:3121 BROOKLAWN CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-1282
Mailing Address - Country:US
Mailing Address - Phone:502-451-5177
Mailing Address - Fax:502-451-0896
Practice Address - Street 1:2104 DAVID GRAVES DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218
Practice Address - Country:US
Practice Address - Phone:502-451-5177
Practice Address - Fax:502-451-0896
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:USPIRITUS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-29
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY950020323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0400004800Medicaid
KY7100254680Medicaid