Provider Demographics
NPI:1972598050
Name:KMI ACQUISITION LLC
Entity type:Organization
Organization Name:KMI ACQUISITION LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR VP CFO
Authorized Official - Prefix:
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:2005-09-15
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY25460174400000X
KY100241283Q00000X, 323P00000X
KY810229324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes283Q00000XHospitalsPsychiatric HospitalGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000054468OtherBC/BS PROVIDER NUMBER
IN100038830AMedicaid
KY2685173000Medicaid
KY008618000OtherMAGELLAN BEHAVIORAL HEALT
KY02021210Medicaid
OH2361377Medicaid
KY45027190Medicaid
KY000000321602OtherANTHEM PROFESSIONAL
KY50005909Medicaid
KY45027190Medicaid
KY02021210Medicaid
IN100038830AMedicaid
KY50005909Medicaid