Organization
TEN BROECK DUPONT INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN HOLLINSWORTH (CHIEF EXECUTIVE OFFICER)
(502) 896-0495
Entity
Organization
Contact information
Practice address
1405 BROWNS LN, LOUISVILLE, KY 40207-4608
(502) 896-0495
(502) 893-8792
Mailing address
1405 BROWNS LN, LOUISVILLE, KY 40207-4608
(502) 896-0495
(502) 893-8792
Taxonomy
Speciality
Code
Description
License number
State
283Q00000X
Psychiatric Hospital
Primary
100595
KY
323P00000X
Psychiatric Residential Treatment Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02000008
—
KY
05
—
45000221
—
KY
Enumeration date
01/09/2006
Last updated
04/20/2008
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