Provider Demographics
NPI:1841566387
Name:FATHER MALONEY'S BOYS' HAVEN, INC.
Entity Type:Organization
Organization Name:FATHER MALONEY'S BOYS' HAVEN, INC.
Other - Org Name:BOYS AND GIRLS HAVEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSH
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:SWETNAM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:502-458-1171
Mailing Address - Street 1:2301 GOLDSMITH LANE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-1018
Mailing Address - Country:US
Mailing Address - Phone:502-458-1171
Mailing Address - Fax:502-451-2161
Practice Address - Street 1:2301 GOLDSMITH LANE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-1018
Practice Address - Country:US
Practice Address - Phone:502-458-1171
Practice Address - Fax:502-451-2161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-29
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
KY251B00000X, 251S00000X
KY500449253J00000X
KY500006322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No253J00000XAgenciesFoster Care Agency
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100272600Medicaid
KY29100229Medicaid
KY29200227Medicaid