Provider Demographics
NPI:1275687337
Name:BUFFALO TRACE CHILDRENS ADVOCACY CENTER
Entity type:Organization
Organization Name:BUFFALO TRACE CHILDRENS ADVOCACY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HOPE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW CSW
Authorized Official - Phone:606-563-0572
Mailing Address - Street 1:PO BOX 645
Mailing Address - Street 2:
Mailing Address - City:MAYSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41056
Mailing Address - Country:US
Mailing Address - Phone:606-563-0572
Mailing Address - Fax:606-563-0574
Practice Address - Street 1:224 LIMESTONE STREET
Practice Address - Street 2:
Practice Address - City:MAYSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41056
Practice Address - Country:US
Practice Address - Phone:606-563-0572
Practice Address - Fax:606-563-0574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY13000138Medicaid