1033110341 NPI number — LAUREL HOUSING INC

Table of content: MS. JILL Y. MONGER PT (NPI 1760444640)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033110341 NPI number — LAUREL HOUSING INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAUREL HOUSING 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:
Provider Other Organization Name Type Code:
6
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:
1033110341
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1800
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONDON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40743-1800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-864-4155
Provider Business Mailing Address Fax Number:
606-878-6780

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
208 W 12TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONDON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40741-1101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-864-4155
Provider Business Practice Location Address Fax Number:
606-878-6780
Provider Enumeration Date:
08/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
YOUNG
Authorized Official First Name:
KATHEY
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
606-864-4155

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  100280 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 36130900 . This is a "BLACK LUNG" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 12500815 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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