Healthcare Provider Details

I. General information

NPI: 1215082466
Provider Name (Legal Business Name): KENTUCKY RIVER AREA DEV DIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 12/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 PERRY PARK ROAD
HAZARD KY
41701
US

IV. Provider business mailing address

917 PERRY PARK RD.
HAZARD KY
41701
US

V. Phone/Fax

Practice location:
  • Phone: 606-436-3158
  • Fax: 606-436-2144
Mailing address:
  • Phone: 606-436-3158
  • Fax: 606-436-3154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. MICHELLE L. ALLEN
Title or Position: FINANCE OFFICER
Credential:
Phone: 606-436-3158