Provider Demographics
NPI:1235234253
Name:KENTUCKY EASTER SEAL SOCIETY INC
Entity Type:Organization
Organization Name:KENTUCKY EASTER SEAL SOCIETY INC
Other - Org Name:CARDINAL HILL REHABILITATION UNIT AT SAMARITAN HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:GIL
Authorized Official - Last Name:GILLIHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-254-5701
Mailing Address - Street 1:PO BOX 8687
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40533
Mailing Address - Country:US
Mailing Address - Phone:859-254-5701
Mailing Address - Fax:859-233-1615
Practice Address - Street 1:310 S LIMESTONE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508
Practice Address - Country:US
Practice Address - Phone:859-226-7700
Practice Address - Fax:859-226-7355
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KENTUCKY EASTER SEAL SOCIETY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-14
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100743314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000379716OtherANTHEM
KY000000379716OtherANTHEM
KY2640106000Medicare ID - Type UnspecifiedPASSPORT MEDICARE