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General NPI Number Information
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NPI Number | 1023478732
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Entity Type | Organization
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Legal Business Name | TRI-COUNTY COMMUNITY ACTION AGENCY, INC.
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Dates
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Enumeration Date | 02/24/2016
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Last Update Date | 02/24/2016
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Provider Practice Location Address
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Address Line | 1015 DISPATCHERS WAY
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City | LA GRANGE
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State | KY
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Zip | 40031-8733
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Country | US
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Telephone | 502-222-1349
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Fax | 502-222-0968
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Provider Business Mailing Address
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Address Line | 1015 DISPATCHERS WAY
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City | LA GRANGE
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State | KY
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Zip | 40031-8733
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Country | US
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Telephone | 502-222-1349
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Fax | 502-222-0968
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. BRENDA LYNN FOX
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Credential |
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Telephone | 502-222-1349
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | 750190
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License Number State | KY
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