Provider Demographics
NPI:1083331417
Name:RK, ADC, LLC
Entity Type:Organization
Organization Name:RK, ADC, LLC
Other - Org Name:GATHERING CLUB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MINNIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-365-2586
Mailing Address - Street 1:4940 HAZELWOOD AVENUE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40214-1270
Mailing Address - Country:US
Mailing Address - Phone:502-819-1297
Mailing Address - Fax:
Practice Address - Street 1:4936 BROWNSBORO ROAD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222
Practice Address - Country:US
Practice Address - Phone:502-365-2586
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RK ADC LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-10-26
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100272830Medicaid
KY7100775650Medicaid
KY750220OtherCABINET FOR HEALTH AND FAMILY SERVICES - ADHC LICENSE - EAST END
KY7100686200Medicaid
KY750185OtherCABINET FOR HEALTH AND FAMILY SERVICES - ADHC LICENSE - SOUTH END
KY7100736930Medicaid