Provider Demographics
NPI:1114052057
Name:KYPPEC,INC
Entity Type:Organization
Organization Name:KYPPEC,INC
Other - Org Name:THE KIDZ CLUB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:MR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:B
Authorized Official - Last Name:ZIMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-210-5538
Mailing Address - Street 1:1101 HERR LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-4301
Mailing Address - Country:US
Mailing Address - Phone:502-210-5538
Mailing Address - Fax:502-327-5098
Practice Address - Street 1:1101 HERR LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4301
Practice Address - Country:US
Practice Address - Phone:502-210-5538
Practice Address - Fax:502-327-5098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7600013140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY45000098Medicaid
KY50000542OtherKY PASSPORT PROVIDER NUMB