Provider Demographics
NPI:1417250077
Name:KENTUCKIANA BEHAVIORAL SERVICES LLC
Entity Type:Organization
Organization Name:KENTUCKIANA BEHAVIORAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:GOEPPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-254-7994
Mailing Address - Street 1:324 TUCKER STATION RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-1359
Mailing Address - Country:US
Mailing Address - Phone:502-254-7994
Mailing Address - Fax:
Practice Address - Street 1:324 TUCKER STATION RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-1359
Practice Address - Country:US
Practice Address - Phone:502-254-7994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-20
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care