Provider Demographics
NPI:1689221764
Name:BARNABAS HOME INC
Entity Type:Organization
Organization Name:BARNABAS HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL TREATMENT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZA
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:CLONTZ
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC LCADC CSS
Authorized Official - Phone:606-364-3640
Mailing Address - Street 1:PO BOX 209
Mailing Address - Street 2:
Mailing Address - City:ANNVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40402-0209
Mailing Address - Country:US
Mailing Address - Phone:606-364-3640
Mailing Address - Fax:606-364-2534
Practice Address - Street 1:95 CAMPUS DRIVE
Practice Address - Street 2:
Practice Address - City:ANNVILLE
Practice Address - State:KY
Practice Address - Zip Code:40402
Practice Address - Country:US
Practice Address - Phone:606-364-3640
Practice Address - Fax:606-364-2534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-22
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100283130Medicaid