Healthcare Provider Details

I. General information

NPI: 1760194831
Provider Name (Legal Business Name): PLAY LEARN GROW EARLY CHILDHOOD DEVELOPMENT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2022
Last Update Date: 12/20/2022
Certification Date: 12/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 BROADWAY ST
HORSE CAVE KY
42749-1205
US

IV. Provider business mailing address

308 BROADWAY ST
HORSE CAVE KY
42749-1205
US

V. Phone/Fax

Practice location:
  • Phone: 270-670-5357
  • Fax:
Mailing address:
  • Phone: 270-670-5357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: ANGELA D MICHAEL
Title or Position: INTERDISCIPLINARY EARLY CHILDHOOD
Credential: MAE IECE
Phone: 270-670-5357