Provider Demographics
NPI:1174825871
Name:BOURBON COUNTY SCHOOLS
Entity Type:Organization
Organization Name:BOURBON COUNTY SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOSE
Authorized Official - Prefix:MS
Authorized Official - First Name:SHELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-987-2180
Mailing Address - Street 1:3343 LEXINGTON RD
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:KY
Mailing Address - Zip Code:40361-1000
Mailing Address - Country:US
Mailing Address - Phone:859-987-2180
Mailing Address - Fax:859-987-2182
Practice Address - Street 1:3343 LEXINGTON RD
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:KY
Practice Address - Zip Code:40361-1000
Practice Address - Country:US
Practice Address - Phone:859-987-2180
Practice Address - Fax:859-987-2182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-01
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY=========Medicaid