Provider Demographics
NPI:1740329135
Name:KENTUCKY RIVER CHILDREN'S ADVOCACY CENTER
Entity type:Organization
Organization Name:KENTUCKY RIVER CHILDREN'S ADVOCACY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:W
Authorized Official - Last Name:QUILLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-487-9173
Mailing Address - Street 1:465 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-1511
Mailing Address - Country:US
Mailing Address - Phone:606-487-9173
Mailing Address - Fax:606-487-1644
Practice Address - Street 1:465 CEDAR ST
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-1511
Practice Address - Country:US
Practice Address - Phone:606-487-9173
Practice Address - Fax:606-487-1644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY13000062Medicaid