Provider Demographics
NPI:1811741887
Name:SUBLIME HEALING LLC
Entity type:Organization
Organization Name:SUBLIME HEALING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KANDACE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BARKHAM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LCADC
Authorized Official - Phone:502-408-5567
Mailing Address - Street 1:7549 MANSLICK RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40214-4182
Mailing Address - Country:US
Mailing Address - Phone:502-408-5567
Mailing Address - Fax:
Practice Address - Street 1:8134 NEW LA GRANGE RD STE 228
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4678
Practice Address - Country:US
Practice Address - Phone:502-408-5677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-15
Last Update Date:2024-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilityGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100914830Medicaid