Healthcare Provider Details

I. General information

NPI: 1114064169
Provider Name (Legal Business Name): KENTUCKY EASTER SEAL SOCIETY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 08/06/2020
Certification Date: 08/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 VERSAILLES ROAD
LEXINGTON KY
40504
US

IV. Provider business mailing address

2050 VERSAILLES ROAD
LEXINGTON KY
40504
US

V. Phone/Fax

Practice location:
  • Phone: 859-367-7217
  • Fax: 859-367-7155
Mailing address:
  • Phone: 859-367-7217
  • Fax: 859-367-7155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number750093
License Number StateKY

VIII. Authorized Official

Name: SHARON A DELLECHIAIE
Title or Position: ACCOUNTING MANAGER
Credential:
Phone: 859-246-8814