Healthcare Provider Details

I. General information

NPI: 1518249879
Provider Name (Legal Business Name): KENTUCKY EASTER SEAL SOCIETY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2011
Last Update Date: 09/13/2011
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 TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. MARTIN LAUTNER
Title or Position: VP/CFO
Credential:
Phone: 859-254-5701