Provider Demographics
NPI:1063857373
Name:VOLUNTEERS OF AMERICA MID-STATES
Entity Type:Organization
Organization Name:VOLUNTEERS OF AMERICA MID-STATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP PROGRAM SERVICES CENTRAL REGION
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCMINN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:502-314-0100
Mailing Address - Street 1:570 S 4TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-2504
Mailing Address - Country:US
Mailing Address - Phone:502-636-0771
Mailing Address - Fax:502-637-8111
Practice Address - Street 1:1436 S SHELBY ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1107
Practice Address - Country:US
Practice Address - Phone:502-636-0742
Practice Address - Fax:502-636-0597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-01
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY800145OtherBHSO