1508148602 NPI number — COMMUNITY SERVICES OF NORTHERN KENTUCKY

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 1508148602 NPI number — COMMUNITY SERVICES OF NORTHERN KENTUCKY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY SERVICES OF NORTHERN KENTUCKY
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:
THE BILL & BETSY SCHEBEN CARE CENTER
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:
1508148602
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/01/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
31 SPIRAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLORENCE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41042-1351
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-525-1128
Provider Business Mailing Address Fax Number:
859-371-0899

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
31 SPIRAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLORENCE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41042-1351
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-525-1128
Provider Business Practice Location Address Fax Number:
859-371-0899
Provider Enumeration Date:
09/14/2011

Additional Information

Authorized Official

Authorized Official Last Name:
WEST
Authorized Official First Name:
LISA
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
859-525-1128

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X , with the licence number:  751064 , 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: 7100163590 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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