NPIMap

Organization Active NPI

Unbound Life LLC

  • Substance Abuse Rehabilitation Facility
  • Elizabethtown, KY
National Provider Identifier
1194456962
Registry record updated Jan 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
Legal business name
UNBOUND LIFE LLC
Practice address
100 Par LN Ste 102
Elizabethtown, KY 42701-9059
Phone
(270) 506-3385
NPI assigned
Jun 22, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Cameron VanceNPI 1447888706
Title
Administrator
Phone
(270) 320-2605

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Substance Abuse Rehabilitation Facility 324500000X Primary

Addresses

Primary practice location

100 Par LN Ste 102
Elizabethtown, KY 42701-9059

Mailing address

100 Par LN Ste 102
Elizabethtown, KY 42701-9059

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230307001621 KY Part B Supplier - Clinic/Group Practice 5193198448 Practice locations: Elizabethtown, KY

National Provider Directory

National Provider Directory

Locations

970 Bloomfield Rd
Bardstown, KY 40004
Phone (270) 209-2124

100 Par Ln
Ste 102
Elizabethtown, KY 42701
Phone (270) 312-2500

Practitioners & affiliated clinicians

Practitioners 53

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 53

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1655856000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673308800000",
    "number": "1194456962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 PAR LN STE 102",
            "city": "ELIZABETHTOWN",
            "state": "KY",
            "postal_code": "427019059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 PAR LN STE 102",
            "city": "ELIZABETHTOWN",
            "state": "KY",
            "postal_code": "427019059",
            "telephone_number": "270-506-3385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNBOUND LIFE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-22",
        "last_updated": "2023-01-10",
        "certification_date": "2023-01-10",
        "status": "A",
        "authorized_official_last_name": "VANCE",
        "authorized_official_first_name": "CAMERON",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "270-320-2605",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elizabethtown, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.