Healthcare Provider Details

I. General information

NPI: 1942699665
Provider Name (Legal Business Name): FINCK SUPPORTED LIVING SERVICES OF KENTUCKY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2015
Last Update Date: 01/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1170 MACKVILLE RD
SPRINGFIELD KY
40069-9700
US

IV. Provider business mailing address

1170 MACKVILLE RD
SPRINGFIELD KY
40069-9700
US

V. Phone/Fax

Practice location:
  • Phone: 573-721-6282
  • Fax:
Mailing address:
  • Phone: 573-721-6282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. SARA MARIE LYNN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 573-721-6282