# BELLEWOOD PRESBYTERIAN HOME FOR CHILDREN

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1851435705
- **Authorized official:** MR. JERRY L CANTRELL LMFT (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (502) 245-4171

## Contact information

- **Practice address:** 11103 PARK RD, LOUISVILLE, KY 40223-2424
- **Practice address phone:** (502) 245-4171
- **Practice address fax:** (502) 245-7447
- **Mailing address:** PO BOX 23309, LOUISVILLE, KY 40223-0309
- **Mailing address phone:** (502) 245-4171
- **Mailing address fax:** (502) 245-7447

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | — | KY | Yes |

## Other

- **Enumeration date:** 02/16/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 29900016 | — | KY |
| 05 | — | 65936098 | — | KY |