Provider Demographics
NPI:1649994898
Name:NEXT LEVEL SUPPORTIVE SERVICES
Entity type:Organization
Organization Name:NEXT LEVEL SUPPORTIVE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ELIJAH
Authorized Official - Middle Name:J
Authorized Official - Last Name:CARRADINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-526-8256
Mailing Address - Street 1:1407 BELMAR DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40213-1703
Mailing Address - Country:US
Mailing Address - Phone:502-526-8256
Mailing Address - Fax:
Practice Address - Street 1:1407 BELMAR DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40213-1703
Practice Address - Country:US
Practice Address - Phone:502-526-8256
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-30
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health