Provider Demographics
NPI:1275311128
Name:KRISTY LOVE RECOVERY CENTER LLC
Entity Type:Organization
Organization Name:KRISTY LOVE RECOVERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:RENFRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-509-8363
Mailing Address - Street 1:333 S PRESTON ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1503
Mailing Address - Country:US
Mailing Address - Phone:859-502-5098
Mailing Address - Fax:
Practice Address - Street 1:333 S PRESTON ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1503
Practice Address - Country:US
Practice Address - Phone:859-502-5098
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health