Provider Demographics
NPI:1821392135
Name:THE METHODIST HOME OF KY
Entity Type:Organization
Organization Name:THE METHODIST HOME OF KY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF PROGRAMS AND SERV
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVY-JOY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:859-523-4651
Mailing Address - Street 1:PO BOX 930
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40340-9800
Mailing Address - Country:US
Mailing Address - Phone:859-523-3001
Mailing Address - Fax:859-241-3787
Practice Address - Street 1:1115 ASHGROVE ROAD
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356
Practice Address - Country:US
Practice Address - Phone:859-523-3001
Practice Address - Fax:859-241-3787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-29
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5000351041C0700X, 322D00000X, 3245S0500X
KY500325251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, ChildrenGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100280770Medicaid
KY7100277030Medicaid
KY7100278700Medicaid
KY7100278730Medicaid
KY7100291300Medicaid