Provider Demographics
NPI:1730363862
Name:RESOURCES FOR EDUCATION, ADAPTATION, CHANGE, AND HEALTH, INC.
Entity type:Organization
Organization Name:RESOURCES FOR EDUCATION, ADAPTATION, CHANGE, AND HEALTH, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:ILLBACK
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:502-585-1911
Mailing Address - Street 1:501 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40208-2318
Mailing Address - Country:US
Mailing Address - Phone:502-585-1911
Mailing Address - Fax:501-589-1582
Practice Address - Street 1:501 PARK AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40208-2318
Practice Address - Country:US
Practice Address - Phone:502-585-1911
Practice Address - Fax:501-589-1582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-26
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X
KY251B00000X, 251S00000X
KY500165253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251B00000XAgenciesCase Management
No253J00000XAgenciesFoster Care Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY29101953Medicaid
KY33001108Medicaid