Provider Demographics
NPI:1245978089
Name:NORTHERN KENTUCKY BEHAVIORAL, LLC
Entity type:Organization
Organization Name:NORTHERN KENTUCKY BEHAVIORAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDENT CORPORATE DEV
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:E
Authorized Official - Last Name:ROURKE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:972-467-4461
Mailing Address - Street 1:PO BOX 4394
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-0016
Mailing Address - Country:US
Mailing Address - Phone:737-471-1800
Mailing Address - Fax:732-747-1818
Practice Address - Street 1:2335 STERLINGTON RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-3937
Practice Address - Country:US
Practice Address - Phone:859-721-1425
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-23
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No283Q00000XHospitalsPsychiatric Hospital