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General NPI Number Information
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NPI Number | 1710012000
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Entity Type | Organization
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Legal Business Name | LIFETIME POTENTIALS, INC.
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Dates
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Enumeration Date | 02/23/2007
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Last Update Date | 10/11/2017
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Provider Practice Location Address
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Address Line | 43 LJ LANE
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City | JACKSON
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State | KY
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Zip | 41339
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Country | US
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Telephone | 606-693-0994
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Fax | 606-693-0959
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Provider Business Mailing Address
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Address Line | PO BOX 798
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City | JACKSON
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State | KY
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Zip | 41339
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Country | US
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Telephone | 606-693-0994
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Fax | 606-693-0959
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Authorized Official
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Title or Position | PRESIDENT
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Name | KAY LEE VANOVER
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Credential |
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Telephone | 606-693-0994
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 007700784
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State | KY
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