Healthcare Provider Details

I. General information

NPI: 1124233085
Provider Name (Legal Business Name): BUFFALO TRACE AREA DEVELOPMENT DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 GOVERNMENT ST SUITE 300
MAYSVILLE KY
41056-1260
US

IV. Provider business mailing address

201 GOVERNMENT ST SUITE 300
MAYSVILLE KY
41056-1260
US

V. Phone/Fax

Practice location:
  • Phone: 606-564-6894
  • Fax: 606-564-0955
Mailing address:
  • Phone: 606-564-6894
  • Fax: 606-564-0955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. CAROLINE CLARKE ULLERY
Title or Position: DIRECTOR OF AGING SERVICES
Credential:
Phone: 606-564-6894