Provider Demographics
NPI: | 1528017142 |
---|---|
Name: | KENTUCKY RIVER COMMUNITY CARE, INC |
Entity Type: | Organization |
Organization Name: | KENTUCKY RIVER COMMUNITY CARE, INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CFO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MARCIA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | ADAMS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 606-666-4351 |
Mailing Address - Street 1: | 115 ROCKWOOD LN |
Mailing Address - Street 2: | |
Mailing Address - City: | HAZARD |
Mailing Address - State: | KY |
Mailing Address - Zip Code: | 41701-9415 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 606-436-5761 |
Mailing Address - Fax: | 606-436-5797 |
Practice Address - Street 1: | 115 ROCKWOOD LN |
Practice Address - Street 2: | |
Practice Address - City: | HAZARD |
Practice Address - State: | KY |
Practice Address - Zip Code: | 41701-9415 |
Practice Address - Country: | US |
Practice Address - Phone: | 606-436-4071 |
Practice Address - Fax: | 606-436-5797 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-05-09 |
Last Update Date: | 2023-09-19 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
No | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | Group - Multi-Specialty | |
No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
No | 101YS0200X | Behavioral Health & Social Service Providers | Counselor | School | Group - Multi-Specialty |
No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
No | 103TS0200X | Behavioral Health & Social Service Providers | Psychologist | School | Group - Multi-Specialty |
No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
No | 174400000X | Other Service Providers | Specialist | Group - Multi-Specialty | |
No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
No | 261QP2300X | Ambulatory Health Care Facilities | Clinic/Center | Primary Care | Group - Multi-Specialty |
No | 320800000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness | Group - Multi-Specialty | |
No | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
KY | 30612022 | Medicaid | |
KY | 30612022 | Medicaid | |
KY | 0020 | Medicare ID - Type Unspecified | GROUP NUMBER |