1750392502 NPI number — ABS LINCS KY, LLC

Table of content: (NPI 1750392502)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750392502 NPI number — ABS LINCS KY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABS LINCS KY, 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:
CUMBERLAND HALL
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:
1750392502
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
270 WALTON WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOPKINSVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42240-1912
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-886-1919
Provider Business Mailing Address Fax Number:
270-889-2186

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
270 WALTON WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOPKINSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42240-1912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-886-1919
Provider Business Practice Location Address Fax Number:
270-889-2186
Provider Enumeration Date:
08/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FILTON
Authorized Official First Name:
STEVE
Authorized Official Middle Name:
Authorized Official Title or Position:
SRVP CFO
Authorized Official Telephone Number:
610-768-3300

Provider Taxonomy Codes

  • Taxonomy code: 273R00000X , with the licence number:  100597 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 283Q00000X , with the licence number: 100597 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 323P00000X , with the licence number: 100597 , 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: 45024536 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 04024014 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0402401400 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02021301 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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