Provider Demographics
NPI:1629566500
Name:KENTUCKY CHRISTIAN RECOVERY, LLC
Entity type:Organization
Organization Name:KENTUCKY CHRISTIAN RECOVERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:270-799-1658
Mailing Address - Street 1:1118 S. MAIN ST.
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MORGANTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42261
Mailing Address - Country:US
Mailing Address - Phone:270-288-5058
Mailing Address - Fax:270-288-5080
Practice Address - Street 1:1118 S. MAIN ST.
Practice Address - Street 2:SUITE 3
Practice Address - City:MORGANTOWN
Practice Address - State:KY
Practice Address - Zip Code:42261
Practice Address - Country:US
Practice Address - Phone:270-288-5058
Practice Address - Fax:270-288-5080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-26
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility