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General NPI Number Information
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NPI Number | 1063561702
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Entity Type | Organization
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Legal Business Name | KENTUCKY EASTER SEAL SOCIETY INC
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 9810 BLUEGRASS PARKWAY
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City | LOUISVILLE
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State | KY
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Zip | 40299
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Country | US
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Telephone | 502-584-9781
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Fax | 502-589-2409
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Provider Business Mailing Address
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Address Line | 9810 BLUEGRASS PARKWAY
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City | LOUISVILLE
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State | KY
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Zip | 40299
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Country | US
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Telephone | 502-584-9781
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Fax | 502-589-2409
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Authorized Official
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Title or Position | PRESIDENT CEO
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Name | KERRY GIL GILLIHAN
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Credential |
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Telephone | 859-254-5701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 100501
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License Number State | KY
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