Provider Demographics
NPI:1417486325
Name:NORTHERN KENTUCKY BEHAVIORAL, LLC
Entity Type:Organization
Organization Name:NORTHERN KENTUCKY BEHAVIORAL, LLC
Other - Org Name:SUN BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VP FOR DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:ROURKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-467-4461
Mailing Address - Street 1:PO BOX 4394
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-0016
Mailing Address - Country:US
Mailing Address - Phone:732-747-1800
Mailing Address - Fax:732-747-1818
Practice Address - Street 1:820 DOLWICK DRIVE
Practice Address - Street 2:
Practice Address - City:ERLANGER
Practice Address - State:KY
Practice Address - Zip Code:41018
Practice Address - Country:US
Practice Address - Phone:732-747-1800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-06
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital