=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558400978
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ACTIVE DAY KY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/05/2007
-----------------------------------------------------
Last Update Date | 01/19/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3403 BRECKENRIDGE LN
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40220-3101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-896-1444
-----------------------------------------------------
Fax | 502-893-0095
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6 NESHAMINY INTERPLEX DR STE 401
-----------------------------------------------------
City | TREVOSE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19053-6942
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-642-6600
-----------------------------------------------------
Fax | 215-642-6610
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CONTRACTS MANAGER
-----------------------------------------------------
Name | DEBORA HOCKENBURY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 215-642-6600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------