Provider Demographics
NPI: | 1437695103 |
---|---|
Name: | BALANCED RECOVERY, INC |
Entity Type: | Organization |
Organization Name: | BALANCED RECOVERY, INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PROGRAM DIRECTOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | STEVANIE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | SMITH |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MED, LPCC, LCADC |
Authorized Official - Phone: | 859-687-0416 |
Mailing Address - Street 1: | 151 COCONUT GROVE DR |
Mailing Address - Street 2: | |
Mailing Address - City: | NICHOLASVILLE |
Mailing Address - State: | KY |
Mailing Address - Zip Code: | 40356-2321 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 859-687-0416 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1795 ALYSHEBA WAY |
Practice Address - Street 2: | SUITE 1001 |
Practice Address - City: | LEXINGTON |
Practice Address - State: | KY |
Practice Address - Zip Code: | 40509-2280 |
Practice Address - Country: | US |
Practice Address - Phone: | 859-687-0416 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2017-01-18 |
Last Update Date: | 2017-01-18 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
KY | 324500000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 324500000X | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |