Healthcare Provider Details

I. General information

NPI: 1295880441
Provider Name (Legal Business Name): LINCOLN TRAIL AREA DEVELOPMENT DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/19/2024
Certification Date: 07/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 S PROVIDENT WAY
ELIZABETHTOWN KY
42701-5956
US

IV. Provider business mailing address

750 S PROVIDENT WAY
ELIZABETHTOWN KY
42701-5956
US

V. Phone/Fax

Practice location:
  • Phone: 270-769-2393
  • Fax: 270-769-2993
Mailing address:
  • Phone: 270-769-2393
  • Fax: 270-769-2993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State

VIII. Authorized Official

Name: DANIEL LONDON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 270-769-2393