Provider Demographics
NPI:1033613542
Name:ANNVILLE-KY ADULT DAYCARE, LLC
Entity Type:Organization
Organization Name:ANNVILLE-KY ADULT DAYCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING/BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:J
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-843-6195
Mailing Address - Street 1:78 HIGHWAY 3444
Mailing Address - Street 2:
Mailing Address - City:ANNVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40402-8245
Mailing Address - Country:US
Mailing Address - Phone:606-346-5162
Mailing Address - Fax:606-364-3920
Practice Address - Street 1:78 HIGHWAY 3444
Practice Address - Street 2:
Practice Address - City:ANNVILLE
Practice Address - State:KY
Practice Address - Zip Code:40402-8245
Practice Address - Country:US
Practice Address - Phone:606-346-5162
Practice Address - Fax:606-364-3920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-20
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care