Provider Demographics
NPI:1457711368
Name:BRIDGES OF KENTUCKY, INC.
Entity Type:Organization
Organization Name:BRIDGES OF KENTUCKY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BURLISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-243-1921
Mailing Address - Street 1:969 KEYSTONE WAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-3000
Mailing Address - Country:US
Mailing Address - Phone:270-702-0306
Mailing Address - Fax:
Practice Address - Street 1:1115 TAMARACK RD
Practice Address - Street 2:SUITE 800
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-6984
Practice Address - Country:US
Practice Address - Phone:270-702-0306
Practice Address - Fax:270-570-1162
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:B & B HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-04
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities