Healthcare Provider Details

I. General information

NPI: 1427174408
Provider Name (Legal Business Name): EASTER SEALS WEST KENTUCKY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2229 MILDRED ST.
PADUCAH KY
42001
US

IV. Provider business mailing address

801 N. 29TH ST
PADUCAH KY
42001
US

V. Phone/Fax

Practice location:
  • Phone: 270-443-1200
  • Fax: 270-444-0655
Mailing address:
  • Phone: 270-443-1200
  • Fax: 270-444-0655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. LISA CARRICO
Title or Position: VP ADULT SERVICES
Credential:
Phone: 270-443-1200