Provider Demographics
NPI:1194274613
Name:RECOVERY ON CHESTNUT
Entity type:Organization
Organization Name:RECOVERY ON CHESTNUT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OF CLINICAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:CORY
Authorized Official - Middle Name:
Authorized Official - Last Name:MONEYMAKER
Authorized Official - Suffix:
Authorized Official - Credentials:LCADC, CADC, MSSW
Authorized Official - Phone:502-548-4121
Mailing Address - Street 1:2100 W CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40211-1078
Mailing Address - Country:US
Mailing Address - Phone:502-565-1200
Mailing Address - Fax:
Practice Address - Street 1:2100 W CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40211-1078
Practice Address - Country:US
Practice Address - Phone:502-565-1200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE HEALING PLACE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility