Provider Demographics
NPI:1447452925
Name:NATHANIEL HOUSE, INC.
Entity type:Organization
Organization Name:NATHANIEL HOUSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:DEBOARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-626-3502
Mailing Address - Street 1:PO BOX 2078
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40476-2078
Mailing Address - Country:US
Mailing Address - Phone:859-626-3502
Mailing Address - Fax:859-626-1620
Practice Address - Street 1:137 PINE ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-1941
Practice Address - Country:US
Practice Address - Phone:859-626-3502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33000324251C00000X, 320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services