Kentucky Christian Recovery, LLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

KENTUCKY CHRISTIAN RECOVERY, LLC

Doing business as

Kentucky Christian Recovery Residential

Practice address

263 Huntsville Quality Rd Ste a
Morgantown, KY 42261-7395

Phone

(270) 934-2024

Fax

(270) 934-2108

NPI assigned

Oct 28, 2019

Organization subpart

No

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

Authorized official

Name

Benjamin Thomas West

Title

Owner

Phone

(270) 799-1658

Specialties & licenses 1

Addresses

Other names 1

• Kentucky Christian Recovery Residential Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Kentucky Christian Recovery LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Kentucky Christian Recovery, LLC

  • Substance Abuse Rehabilitation Facility
  • Morgantown, KY
  • NPI 1629566500
  NPD tax ID

Locations

Practitioners 2

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

• Heidi McCormack, LCSW

  • Clinical Social Worker
  • Morgantown, KY
  • NPI 1649991787
  NPD
• Shaye Tomblinson, FNP-C

  • Family Nurse Practitioner
  • Morgantown, KY
  • NPI 1669107538
  NPD (past)

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

{
    "created_epoch": "1572220800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1572220800000",
    "number": "1386287837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1118 S MAIN ST STE 3",
            "city": "MORGANTOWN",
            "state": "KY",
            "postal_code": "422619409",
            "telephone_number": "270-934-2024",
            "fax_number": "270-934-2108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "263 HUNTSVILLE QUALITY RD STE A",
            "city": "MORGANTOWN",
            "state": "KY",
            "postal_code": "422617395",
            "telephone_number": "270-934-2024",
            "fax_number": "270-934-2108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENTUCKY CHRISTIAN RECOVERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-28",
        "last_updated": "2019-10-28",
        "status": "A",
        "authorized_official_last_name": "WEST",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "270-799-1658"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kentucky Christian Recovery Residential",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Joseph Ryan Jackson, D.C.
• John Mark Jennings, LCSW, BCD
• Jessica Danielle Johnson, APRN
• Nolan Johnson
• Kentucky Christian Lab Services LLC
• Kentucky Christian Recovery, LLC
• Andrea Kiernan, LPCC
• Mya Kimberling
• Abby Lacefield
• Vicky Ann Lease, D.C.

• Substance Abuse Rehabilitation Facility in Morgantown, KY
• Providers in Morgantown, KY by specialty
• Substance Abuse Rehabilitation Facility in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.