Provider Demographics
NPI:1477264091
Name:CARDINAL TREATMENT CENTERS KENTUCKY LLC
Entity Type:Organization
Organization Name:CARDINAL TREATMENT CENTERS KENTUCKY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SHKLYAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-343-2772
Mailing Address - Street 1:96 LINWOOD PLAZA, RT 9W
Mailing Address - Street 2:SUITE 303
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024
Mailing Address - Country:US
Mailing Address - Phone:201-398-5185
Mailing Address - Fax:
Practice Address - Street 1:378 DIEDERICH BLVD
Practice Address - Street 2:SUITE 177
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101
Practice Address - Country:US
Practice Address - Phone:516-343-2772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty