Provider Demographics
NPI:1982027199
Name:BHG XXXIII, LLC
Entity Type:Organization
Organization Name:BHG XXXIII, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF LICENSING
Authorized Official - Prefix:
Authorized Official - First Name:JEMECE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:GASAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-365-6126
Mailing Address - Street 1:5001 SPRING VALLEY ROAD,
Mailing Address - Street 2:SUITE 600 EAST
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244
Mailing Address - Country:US
Mailing Address - Phone:214-365-6150
Mailing Address - Fax:214-365-6150
Practice Address - Street 1:2705 OLIVET CHURCH RD
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-9755
Practice Address - Country:US
Practice Address - Phone:270-443-0096
Practice Address - Fax:270-443-0080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-23
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY800197251B00000X
261QM0801X
KY810129261QM2800X
KY261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No251B00000XAgenciesCase Management
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100371080Medicaid
KY7100371080Medicaid