Healthcare Provider Details

I. General information

NPI: 1528110657
Provider Name (Legal Business Name): POWELL ADULT DAY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 08/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 12TH STREET
CLAY CITY KY
40312
US

IV. Provider business mailing address

P.O. BOX 82 176 12TH STREET
CLAY CITY KY
40312
US

V. Phone/Fax

Practice location:
  • Phone: 606-663-0794
  • Fax: 606-663-1254
Mailing address:
  • Phone: 606-663-0794
  • Fax: 606-663-1254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number750105
License Number StateKY

VIII. Authorized Official

Name: MRS. VICKI M JOZEFOWICZ
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 859-624-2046