Healthcare Provider Details

I. General information

NPI: 1881799807
Provider Name (Legal Business Name): KENTUCKY EASTER SEAL SOCIETY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 06/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 VERSAILLES RD
LEXINGTON KY
40504-1405
US

IV. Provider business mailing address

2050 VERSAILLES RD
LEXINGTON KY
40504-1405
US

V. Phone/Fax

Practice location:
  • Phone: 859-254-5701
  • Fax: 859-233-1615
Mailing address:
  • Phone: 859-254-5701
  • Fax: 859-233-1615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number100100
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberP05154
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number100100
License Number StateKY

VIII. Authorized Official

Name: MARTY A. LAUTNER
Title or Position: VICE PRESIDENT/CFO
Credential:
Phone: 859-254-5701