Provider Demographics
NPI:1225451024
Name:BEHAVIORAL HEALTHCARE MANAGEMENT LLC
Entity Type:Organization
Organization Name:BEHAVIORAL HEALTHCARE MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:KRUER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-895-1611
Mailing Address - Street 1:4010 DUPONT CIRCLE
Mailing Address - Street 2:SUITE 565
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4888
Mailing Address - Country:US
Mailing Address - Phone:502-895-1611
Mailing Address - Fax:
Practice Address - Street 1:4010 DUPONT CIR
Practice Address - Street 2:SUITE 565
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4888
Practice Address - Country:US
Practice Address - Phone:502-895-1611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-29
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK118270Medicare PIN
ININ1793Medicare PIN