Provider Demographics
NPI:1184456717
Name:UNBRIDLED HEALTHCARE SYSTEM LLC
Entity type:Organization
Organization Name:UNBRIDLED HEALTHCARE SYSTEM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:TYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-215-3832
Mailing Address - Street 1:222 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-1367
Mailing Address - Country:US
Mailing Address - Phone:606-215-3832
Mailing Address - Fax:
Practice Address - Street 1:222 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-1367
Practice Address - Country:US
Practice Address - Phone:606-215-3832
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNBRIDLED HEALTHCARE SYSTEMS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Multi-Specialty