Provider Demographics
NPI:1578527610
Name:NORTHERN KENTUCKY MENTAL HEALTH MENTAL RETARDATION REGIONAL BOARD
Entity Type:Organization
Organization Name:NORTHERN KENTUCKY MENTAL HEALTH MENTAL RETARDATION REGIONAL BOARD
Other - Org Name:NORTHKEY COMMUNITY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:
Authorized Official - First Name:OWEN
Authorized Official - Middle Name:T
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:859-578-3200
Mailing Address - Street 1:502 FARRELL DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41011-3717
Mailing Address - Country:US
Mailing Address - Phone:859-578-3232
Mailing Address - Fax:859-578-3256
Practice Address - Street 1:502 FARRELL DR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41011-3717
Practice Address - Country:US
Practice Address - Phone:859-578-3232
Practice Address - Fax:859-578-3256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-14
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8000842084P0800X, 261QM0801X, 364SP0812X
261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity HealthGroup - Multi-Specialty
No364SP0812XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, CommunityGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30607030Medicaid
KY6026Medicare PIN
KY6037Medicare PIN
KY6036Medicare PIN
KY30607030Medicaid
KY0256Medicare PIN