Provider Demographics
NPI:1871317180
Name:NEULIFE REHABILITATION OF KENTUCKY INC
Entity type:Organization
Organization Name:NEULIFE REHABILITATION OF KENTUCKY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-936-5433
Mailing Address - Street 1:189 ADAM SHEPHERD PARKWAY, SUITE 17
Mailing Address - Street 2:PMB #280
Mailing Address - City:SHEPHERDSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40165
Mailing Address - Country:US
Mailing Address - Phone:844-936-5433
Mailing Address - Fax:
Practice Address - Street 1:1125 31W BYPASS
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101
Practice Address - Country:US
Practice Address - Phone:844-936-5433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
No251S00000XAgenciesCommunity/Behavioral Health