Provider Demographics
NPI:1699219162
Name:REKINDLED, LIMITED LIABILITY COMPANY
Entity Type:Organization
Organization Name:REKINDLED, LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HASKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-682-7150
Mailing Address - Street 1:365 DUKE ROAD
Mailing Address - Street 2:SUITE# 2561
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40522
Mailing Address - Country:US
Mailing Address - Phone:859-359-2004
Mailing Address - Fax:
Practice Address - Street 1:365 DUKE ROAD
Practice Address - Street 2:SUITE# 2561
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40522
Practice Address - Country:US
Practice Address - Phone:859-359-2004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-18
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7717251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health