Healthcare Provider Details

I. General information

NPI: 1518176866
Provider Name (Legal Business Name): FAMILY TIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 05/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

632 DAVID AVE
DANVILLE KY
40422-9266
US

IV. Provider business mailing address

632 DAVID AVE
DANVILLE KY
40422-9266
US

V. Phone/Fax

Practice location:
  • Phone: 859-326-0689
  • Fax: 859-236-7987
Mailing address:
  • Phone: 859-326-0689
  • Fax: 859-236-7987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateKY

VIII. Authorized Official

Name: AMBER ESTES
Title or Position: OWNER PROGRAM SUPERVISOR
Credential: LPN
Phone: 859-326-0689