1750465571 NPI number — KENTUCKY EASTER SEAL SOCIETY INC

Table of content: (NPI 1750465571)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750465571 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 OF NORTHERN KENTUCKY
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:
1750465571
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4727
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:
40544-4727
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:
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
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:
859-525-0351
Provider Enumeration Date:
10/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WILSON
Authorized Official First Name:
TIM
Authorized Official Middle Name:
M
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:  100940 , 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: 7717311 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 94 . This is a "FIRST STEPS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000336625 . This is a "ANTHEM PT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000336653 . This is a "ANTHEM OT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000336691 . This is a "ANTHEM ST" identifier . This identifiers is of the category "OTHER".




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