Provider Demographics
NPI:1487936449
Name:FLORENCE CRITTENTON HOME
Entity type:Organization
Organization Name:FLORENCE CRITTENTON HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:859-252-8636
Mailing Address - Street 1:519 W FOURTH ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40508-1205
Mailing Address - Country:US
Mailing Address - Phone:859-252-8636
Mailing Address - Fax:859-252-5546
Practice Address - Street 1:519 W FOURTH ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-1205
Practice Address - Country:US
Practice Address - Phone:859-252-8636
Practice Address - Fax:859-252-5546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY500066322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children