1104119239 NPI number — EXCELLENT SERVICES OF KENTUCKY LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104119239 NPI number — EXCELLENT SERVICES OF KENTUCKY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EXCELLENT SERVICES OF KENTUCKY LLC
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:
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:
1104119239
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4965 US HIGHWAY 42
Provider Second Line Business Mailing Address:
SUITE 1000
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40222-6372
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-774-0767
Provider Business Mailing Address Fax Number:
888-774-8022

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4965 US HIGHWAY 42
Provider Second Line Business Practice Location Address:
SUITE 1000
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40222-6372
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-774-0767
Provider Business Practice Location Address Fax Number:
888-774-8022
Provider Enumeration Date:
05/23/2011

Additional Information

Authorized Official

Authorized Official Last Name:
WESTON
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
H
Authorized Official Title or Position:
CHAIRMAN OF THE BOARD
Authorized Official Telephone Number:
317-557-6430

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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