Provider Demographics
NPI:1730595638
Name:THE KY UNITED METHODIST HOME
Entity type:Organization
Organization Name:THE KY UNITED METHODIST HOME
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CAMPUS DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARR
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:270-683-6481
Mailing Address - Street 1:201 PHILLIPS CT
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-3772
Mailing Address - Country:US
Mailing Address - Phone:270-683-6481
Mailing Address - Fax:270-926-0817
Practice Address - Street 1:201 PHILLIPS CT
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-3772
Practice Address - Country:US
Practice Address - Phone:270-683-6481
Practice Address - Fax:270-926-0817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-11
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY600161251B00000X
KY600148322D00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children