Provider Demographics
NPI:1679032981
Name:GORE BEHAVIORAL CARE, LLC
Entity Type:Organization
Organization Name:GORE BEHAVIORAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:GORE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:270-938-5765
Mailing Address - Street 1:737 LAURELWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-6008
Mailing Address - Country:US
Mailing Address - Phone:270-599-2419
Mailing Address - Fax:
Practice Address - Street 1:855 LOVERS LN STE 106
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-7989
Practice Address - Country:US
Practice Address - Phone:270-938-5765
Practice Address - Fax:833-471-3546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-16
Last Update Date:2019-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty