Provider Demographics
NPI:1497345235
Name:ADVANCED PRIMARY & BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:ADVANCED PRIMARY & BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCCLURE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:859-624-2290
Mailing Address - Street 1:2013 MERCHANT DR STE 3
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-6856
Mailing Address - Country:US
Mailing Address - Phone:859-624-2290
Mailing Address - Fax:859-624-5455
Practice Address - Street 1:2013 MERCHANT DR STE 3
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-6856
Practice Address - Country:US
Practice Address - Phone:859-624-2290
Practice Address - Fax:859-624-5455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-26
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100741800Medicaid
KY18D2223057OtherCLIA