Healthcare Provider Details

I. General information

NPI: 1043703572
Provider Name (Legal Business Name): AFTON COMMUNIY DAY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2018
Last Update Date: 06/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3743 RED RIVER DR
LEXINGTON KY
40517-3351
US

IV. Provider business mailing address

285 MEDLOCK RD
LEXINGTON KY
40517-1150
US

V. Phone/Fax

Practice location:
  • Phone: 859-619-9721
  • Fax:
Mailing address:
  • Phone: 859-619-9721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM HUBBARD
Title or Position: MEMBER
Credential:
Phone: 859-619-9721