Provider Demographics
NPI:1043244379
Name:ACTIVE DAY KY, INC.
Entity Type:Organization
Organization Name:ACTIVE DAY KY, INC.
Other - Org Name:ACTIVE DAY OF LOUISVILLE HIKES POINT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR AND PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:W
Authorized Official - Last Name:BALDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:NOT APPLICABLE
Authorized Official - Phone:443-548-2201
Mailing Address - Street 1:400 REDLAND CT
Mailing Address - Street 2:SUITE 114
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-3270
Mailing Address - Country:US
Mailing Address - Phone:443-548-2200
Mailing Address - Fax:443-548-2260
Practice Address - Street 1:3403 BRECKENRIDGE LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-3101
Practice Address - Country:US
Practice Address - Phone:502-896-1444
Practice Address - Fax:502-893-0095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPENDING261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation