Provider Demographics
NPI:1386318616
Name:PRESBYTERIAN CHILD WELFARE AGENCY, INC
Entity type:Organization
Organization Name:PRESBYTERIAN CHILD WELFARE AGENCY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KENNITH
Authorized Official - Middle Name:MITCHELL
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-398-7000
Mailing Address - Street 1:116 BUCKHORN LN
Mailing Address - Street 2:
Mailing Address - City:BUCKHORN
Mailing Address - State:KY
Mailing Address - Zip Code:41721-8987
Mailing Address - Country:US
Mailing Address - Phone:606-398-7000
Mailing Address - Fax:
Practice Address - Street 1:1355 CEDAR POINT RD
Practice Address - Street 2:
Practice Address - City:BUCKHORN
Practice Address - State:KY
Practice Address - Zip Code:41721
Practice Address - Country:US
Practice Address - Phone:606-398-5077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-02
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility