Provider Demographics
NPI:1235307521
Name:JESSAMINE COUNTY ASSOCIATION FOR EXCEPTIONAL CITIZENS
Entity Type:Organization
Organization Name:JESSAMINE COUNTY ASSOCIATION FOR EXCEPTIONAL CITIZENS
Other - Org Name:JCAEC
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:A
Authorized Official - Last Name:DIETRICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-885-9383
Mailing Address - Street 1:PO BOX 302
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40340-0302
Mailing Address - Country:US
Mailing Address - Phone:859-885-9383
Mailing Address - Fax:
Practice Address - Street 1:109 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-1541
Practice Address - Country:US
Practice Address - Phone:859-885-9383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services