Provider Demographics
NPI:1811029176
Name:PRESBYTERIAN CHILD WELFARE AGENCY
Entity Type:Organization
Organization Name:PRESBYTERIAN CHILD WELFARE AGENCY
Other - Org Name:BUCKHORN CHILDREN AND FAMILY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MITCH
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-398-7000
Mailing Address - Street 1:116 BUCKHORN LN
Mailing Address - Street 2:
Mailing Address - City:BUCKHORN
Mailing Address - State:KY
Mailing Address - Zip Code:41721-8987
Mailing Address - Country:US
Mailing Address - Phone:606-398-7000
Mailing Address - Fax:606-398-7912
Practice Address - Street 1:116 BUCKHORN LN
Practice Address - Street 2:
Practice Address - City:BUCKHORN
Practice Address - State:KY
Practice Address - Zip Code:41721-8987
Practice Address - Country:US
Practice Address - Phone:606-398-7000
Practice Address - Fax:606-398-7912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH552251B00000X
251B00000X, 251S00000X, 324500000X
KY097123960(1)322D00000X
KY097122583(2)323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100258860Medicaid
KY7100258880Medicaid
KY810858OtherKY OIG - OUTPATIENT AODE
KY810859OtherKY OIG - OUTPATIENT AODE
KY04097010Medicaid
OH12394Medicaid
KY04097028Medicaid