1881799807 NPI number — KENTUCKY EASTER SEAL SOCIETY INC

Table of content: (NPI 1881799807)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881799807 NPI number — KENTUCKY EASTER SEAL SOCIETY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KENTUCKY EASTER SEAL SOCIETY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CARDINAL HILL REHABILITATION HOSPITAL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881799807
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/08/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2050 VERSAILLES RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40504-1405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-254-5701
Provider Business Mailing Address Fax Number:
859-233-1615

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2050 VERSAILLES RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40504-1405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-254-5701
Provider Business Practice Location Address Fax Number:
859-233-1615
Provider Enumeration Date:
09/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LAUTNER
Authorized Official First Name:
MARTY
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
VICE PRESIDENT/CFO
Authorized Official Telephone Number:
859-254-5701

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  100100 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 283X00000X , with the licence number: 100100 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 333600000X , with the licence number: P05154 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2638739 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01021237 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1062621 . This is a "PASSPORT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 253 . This is a "FIRST STEPS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000054501 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".




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