1528110657 NPI number — POWELL ADULT DAY CARE

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 1528110657 NPI number — POWELL ADULT DAY CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
POWELL ADULT DAY CARE
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:
1528110657
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 82
Provider Second Line Business Mailing Address:
176 12TH STREET
Provider Business Mailing Address City Name:
CLAY CITY
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40312
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-663-0794
Provider Business Mailing Address Fax Number:
606-663-1254

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
176 12TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLAY CITY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-663-0794
Provider Business Practice Location Address Fax Number:
606-663-1254
Provider Enumeration Date:
01/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JOZEFOWICZ
Authorized Official First Name:
VICKI
Authorized Official Middle Name:
M
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
859-624-2046

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X , with the licence number:  750105 , 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: 43000017 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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