Provider Demographics
NPI:1033550942
Name:COMMONWEALTH TREATMENT CENTER
Entity Type:Organization
Organization Name:COMMONWEALTH TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:GREGG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-235-5308
Mailing Address - Street 1:73 C MICHAEL DAVENPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601
Mailing Address - Country:US
Mailing Address - Phone:502-317-8172
Mailing Address - Fax:859-317-8172
Practice Address - Street 1:73 C MICHAEL DAVENPORT BLVD
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-4475
Practice Address - Country:US
Practice Address - Phone:502-317-8172
Practice Address - Fax:859-317-8172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility