Healthcare Provider Details

I. General information

NPI: 1063703676
Provider Name (Legal Business Name): COMMUNITY SERVICES OF NORTHERN KENTUCKY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2011
Last Update Date: 11/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 SPIRAL DR
FLORENCE KY
41042-1351
US

IV. Provider business mailing address

31 SPIRAL DR
FLORENCE KY
41042-1351
US

V. Phone/Fax

Practice location:
  • Phone: 859-525-1128
  • Fax: 859-371-0899
Mailing address:
  • Phone: 859-525-1128
  • Fax: 859-371-0899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number750164
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number750164
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number750164
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code347B00000X
TaxonomyBus
License Number
License Number StateKY
# 5
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number751064
License Number StateKY

VIII. Authorized Official

Name: LISA WEST
Title or Position: EXECUTIVE DIRECTOR
Credential: CNE, CNC
Phone: 859-525-1128