Provider Demographics
NPI:1104097021
Name:KMI ACQUISITION LLC
Entity type:Organization
Organization Name:KMI ACQUISITION LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:FILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-768-3300
Mailing Address - Street 1:8521 LAGRANGE RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40242-3800
Mailing Address - Country:US
Mailing Address - Phone:502-426-6380
Mailing Address - Fax:502-814-3711
Practice Address - Street 1:8521 LAGRANGE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40242-3800
Practice Address - Country:US
Practice Address - Phone:502-426-6380
Practice Address - Fax:502-814-3711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2084P0800X
KY100241323P00000X, 283Q00000X
KY810229324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes283Q00000XHospitalsPsychiatric Hospital
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200910090AMedicaid
KY3534130000OtherPASSPORT ADVANTAGE
KY008618000OtherMAGELLAN BEHAVIORAL HEALT
KY7100029460Medicaid
KY7100036170Medicaid
OH2361377Medicaid
KY000000556016OtherANTHEM
OH2361377Medicaid
KY3534130000OtherPASSPORT ADVANTAGE
KY7100036170Medicaid