Provider Demographics
NPI:1235311317
Name:COMMUNITY ACTION OF SOUTHERN KENTUCKY
Entity Type:Organization
Organization Name:COMMUNITY ACTION OF SOUTHERN KENTUCKY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:H
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-782-3162
Mailing Address - Street 1:921 BEAUTY AVE
Mailing Address - Street 2:POST OFFICE BOX 90014
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-6135
Mailing Address - Country:US
Mailing Address - Phone:270-782-3162
Mailing Address - Fax:270-842-5735
Practice Address - Street 1:921 BEAUTY AVE
Practice Address - Street 2:POST OFFICE BOX 90014
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-6135
Practice Address - Country:US
Practice Address - Phone:270-782-3162
Practice Address - Fax:270-842-5735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY5600703200Medicaid