Provider Demographics
NPI:1700385325
Name:JOURNEYPURE LOUISVILLE, LLC
Entity Type:Organization
Organization Name:JOURNEYPURE LOUISVILLE, LLC
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 1:3430 NEWBURG RD STE 208
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-2458
Practice Address - Country:US
Practice Address - Phone:615-347-1358
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