Healthcare Provider Details

I. General information

NPI: 1376616128
Provider Name (Legal Business Name): OLIVIA CARES FOR KENTUCKY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 AVAWAN DR
RICHMOND KY
40475
US

IV. Provider business mailing address

108 AVAWAN DR
RICHMOND KY
40475
US

V. Phone/Fax

Practice location:
  • Phone: 859-624-9163
  • Fax: 859-624-9163
Mailing address:
  • Phone: 859-624-9163
  • Fax: 859-624-9163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN HANNON RAKESTRAW
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 859-624-9163