Healthcare Provider Details

I. General information

NPI: 1235234253
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: 10/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 S LIMESTONE
LEXINGTON KY
40508
US

IV. Provider business mailing address

PO BOX 8687
LEXINGTON KY
40533
US

V. Phone/Fax

Practice location:
  • Phone: 859-226-7700
  • Fax: 859-226-7355
Mailing address:
  • Phone: 859-254-5701
  • Fax: 859-233-1615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number100743
License Number StateKY

VIII. Authorized Official

Name: KERRY GIL GILLIHAN
Title or Position: PRESIDENT CEO
Credential:
Phone: 859-254-5701