Provider Demographics
NPI:1417036575
Name:REGIONAL CHILD DEVELOPMENT CLINICS
Entity Type:Organization
Organization Name:REGIONAL CHILD DEVELOPMENT CLINICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETSY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KITCHENS
Authorized Official - Suffix:
Authorized Official - Credentials:RN,C
Authorized Official - Phone:270-843-8284
Mailing Address - Street 1:1600 SCOTTSVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-3217
Mailing Address - Country:US
Mailing Address - Phone:270-843-8284
Mailing Address - Fax:270-843-8362
Practice Address - Street 1:1600 SCOTTSVILLE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3217
Practice Address - Country:US
Practice Address - Phone:270-843-8284
Practice Address - Fax:270-843-8362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1072556251C00000X
KY3209251C00000X
KY1002251C00000X
KY3128251C00000X
KY1044251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services