Provider Demographics
NPI:1295108553
Name:ST JOSEPH PEACE MISSION FOR CHILDREN
Entity type:Organization
Organization Name:ST JOSEPH PEACE MISSION FOR CHILDREN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:P
Authorized Official - Last Name:YEVINCY
Authorized Official - Suffix:
Authorized Official - Credentials:MSSW
Authorized Official - Phone:270-683-9441
Mailing Address - Street 1:1328 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-1901
Mailing Address - Country:US
Mailing Address - Phone:270-683-9441
Mailing Address - Fax:
Practice Address - Street 1:1328 W 3RD ST
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-1901
Practice Address - Country:US
Practice Address - Phone:270-683-9441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY500608322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children