Healthcare Provider Details

I. General information

NPI: 1144401738
Provider Name (Legal Business Name): THE GROVE AT LEXINGTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2007
Last Update Date: 10/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 CUSTER DR SUITE 201
LEXINGTON KY
40517-4010
US

IV. Provider business mailing address

3150 CUSTER DR SUITE 201
LEXINGTON KY
40517-4010
US

V. Phone/Fax

Practice location:
  • Phone: 859-271-1101
  • Fax: 859-271-1161
Mailing address:
  • Phone: 859-271-1101
  • Fax: 859-271-1161

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 Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number7100043250
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANGELA DAWN TAYLOR
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 859-388-4347