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General NPI Number Information
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NPI Number | 1720123870
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Entity Type | Organization
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Legal Business Name | EASTER SEALS WEST KENTUCKY, INC.
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 12/17/2024
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Provider Practice Location Address
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Address Line | 619 N 30TH ST
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City | PADUCAH
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State | KY
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Zip | 42001-4047
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Country | US
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Telephone | 270-444-9687
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Fax |
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Provider Business Mailing Address
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Address Line | 801 N 29TH ST
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City | PADUCAH
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State | KY
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Zip | 42001-4056
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | LEE HENRY
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Credential |
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Telephone | 270-444-7898
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM3000X
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Taxonomy Name | Medically Fragile Infants and Children Day Care
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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