Organization
BELLEWOOD PRESBYTERIAN HOME FOR CHILDREN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JERRY L CANTRELL LMFT (EXECUTIVE DIRECTOR)
(502) 245-4171
Entity
Organization
Contact information
Practice address
11103 PARK RD, LOUISVILLE, KY 40223-2424
(502) 245-4171
(502) 245-7447
Mailing address
PO BOX 23309, LOUISVILLE, KY 40223-0309
(502) 245-4171
(502) 245-7447
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
29900016
—
KY
05
—
65936098
—
KY
Enumeration date
02/16/2007
Last updated
08/22/2020
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