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KENTUCKIANA DETOX AND REHAB CENTER NPI 1730846817


NPI Information

NPI: 1730846817
Provider Name: KENTUCKIANA DETOX AND REHAB CENTER

Doing Business As: AVENUES RECOVERY CENTER AT KENTUCKIANA

Classification: Substance Abuse Rehabilitation Facility - 324500000X
Entity Type: Organization

CLIA Number: 15D2251099

Address:
4601 MEDICAL PLAZA WAY
CLARKSVILLE, IN
ZIP 47129
Phone: (732) 307-8000
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KENTUCKIANA DETOX AND REHAB CENTER is a substance abuse rehabilitation facility in Clarksville, IN. The provider is a facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. KENTUCKIANA DETOX AND REHAB CENTER NPI is 1730846817. The provider is registered as an organization entity type.
The provider Is Doing Business As Avenues Recovery Center At Kentuckiana.

The provider's business location address is:

4601 MEDICAL PLAZA WAY
CLARKSVILLE, IN
ZIP 47129-204
Phone: (732) 307-8000

The provider's authorized official is Yehuda Alter .
The authorized official title is Ceo and has the following contact phone number (848) 223-4562.

The CLIA number assigned to this NPI record is 15D2251099 - other - addiction treatment provi with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/23/2021 and was last updated on 7/6/2023.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QR0405XClinic/CenterRehabilitation, Substance Use DisorderNo
2324500000XSubstance Abuse Rehabilitation FacilityYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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