Provider Demographics
NPI:1952621005
Name:LIFEWORKS OF KENTUCKY
Entity type:Organization
Organization Name:LIFEWORKS OF KENTUCKY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FOSTER
Authorized Official - Middle Name:
Authorized Official - Last Name:BEEUWKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-326-4141
Mailing Address - Street 1:PO BOX 6381
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-0381
Mailing Address - Country:US
Mailing Address - Phone:502-326-4141
Mailing Address - Fax:502-326-4188
Practice Address - Street 1:1531 ORMSBY STATION CT
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-4019
Practice Address - Country:US
Practice Address - Phone:502-326-4141
Practice Address - Fax:502-326-4188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)