Provider Demographics
NPI:1538668157
Name:JOURNEYPURE PADUCAH
Entity Type:Organization
Organization Name:JOURNEYPURE PADUCAH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-973-3500
Mailing Address - Street 1:5080 FLORENCE RD
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-2922
Mailing Address - Country:US
Mailing Address - Phone:615-907-5037
Mailing Address - Fax:
Practice Address - Street 1:3229 COLEMAN RD
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-6563
Practice Address - Country:US
Practice Address - Phone:270-205-8895
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOURNEYPURE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-02-09
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility