Organization
ALTERNATIVE SERVICES FOR INDIVIDUALS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. FREDERICK DAVIS (EXECUTIVE DIRECTOR)
(502) 493-2512
Entity
Organization
Contact information
Practice address
3924 BARDSTOWN RD, LOUISVILLE, KY 40218-2610
(502) 493-2512
(502) 493-2513
Mailing address
PO BOX 991234, LOUISVILLE, KY 40269-1234
(502) 314-8481
(502) 493-4621
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
311Z00000X
Custodial Care Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33000712
—
KY
Enumeration date
02/26/2007
Last updated
03/11/2015
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