=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659029130
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEADE ASSOCIATION OF REMARKABLE CITIZENS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2022
-----------------------------------------------------
Last Update Date | 03/14/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1910 BRANDENBURG RD
-----------------------------------------------------
City | BRANDENBURG
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40108-9342
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-422-5335
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 234 REBECCA CT
-----------------------------------------------------
City | BRANDENBURG
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40108-9790
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-668-3344
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MR. WILL T. PARKER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 270-668-3344
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------