1063703676 NPI number — COMMUNITY SERVICES OF NORTHERN KENTUCKY

Table of content: (NPI 1063703676)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063703676 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:
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:
1063703676
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:
04/29/2011

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:  750164 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 343900000X , with the licence number: 750164 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 344600000X , with the licence number: 750164 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 347B00000X , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • 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: 7100168480 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100167570 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100163590 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100167590 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100168500 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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