Provider Demographics
NPI:1407426711
Name:EMERALD THERAPY CENTER, LLC
Entity Type:Organization
Organization Name:EMERALD THERAPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:270-534-5128
Mailing Address - Street 1:5050 VILLAGE SQUARE DR STE B
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-7552
Mailing Address - Country:US
Mailing Address - Phone:702-534-5128
Mailing Address - Fax:270-477-0007
Practice Address - Street 1:5050 VILLAGE SQUARE DR STE B
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-7552
Practice Address - Country:US
Practice Address - Phone:702-534-5128
Practice Address - Fax:270-477-0007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health