MEDICARE: AFTON COMMUNIY DAY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1043703572
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFTON COMMUNIY DAY, INC.

Provider Business Mailing Address
First Line	:	285 MEDLOCK RD
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40517-1150
Country	:	US
Telephone Number	:	859-619-9721
Fax Number	:

Provider Business Practice Location Address
First Line	:	3743 RED RIVER DR
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40517-3351
Country	:	US
Telephone Number	:	859-619-9721
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	MR. WILLIAM HUBBARD
Credential	:
Telephone Number	:	859-619-9721

Provider Enumeration Date	:	06/09/2018
Last Update Date	:	06/09/2018

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