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General NPI Number Information
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NPI Number | 1033613542
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Entity Type | Organization
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Legal Business Name | ANNVILLE-KY ADULT DAYCARE, LLC
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Dates
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Enumeration Date | 03/20/2018
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Last Update Date | 03/20/2018
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Provider Practice Location Address
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Address Line | 78 HIGHWAY 3444
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City | ANNVILLE
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State | KY
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Zip | 40402-8245
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Country | US
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Telephone | 606-346-5162
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Fax | 606-364-3920
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Provider Business Mailing Address
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Address Line | 78 HIGHWAY 3444
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City | ANNVILLE
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State | KY
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Zip | 40402-8245
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Country | US
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Telephone | 606-346-5162
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Fax | 606-364-3920
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Authorized Official
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Title or Position | CREDENTIALING/BILLING MANAGER
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Name | CARLA J JOHNSON
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Credential |
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Telephone | 606-843-6195
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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 |
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License Number State |
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