Provider Demographics
NPI:1891442141
Name:RESILIENT THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:RESILIENT THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-826-1243
Mailing Address - Street 1:11500 VALLEY VIEW RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-1353
Mailing Address - Country:US
Mailing Address - Phone:512-826-1243
Mailing Address - Fax:
Practice Address - Street 1:1512 W HIGHWAY 42
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-9554
Practice Address - Country:US
Practice Address - Phone:512-826-1243
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation