Provider Demographics
NPI:1356643548
Name:REACH FOR THE STARS CASE MANAGEMENT
Entity Type:Organization
Organization Name:REACH FOR THE STARS CASE MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:S
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-789-9216
Mailing Address - Street 1:103 TAMMIE TRL
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-3310
Mailing Address - Country:US
Mailing Address - Phone:270-789-9216
Mailing Address - Fax:270-469-0914
Practice Address - Street 1:103 TAMMIE TRL
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-3310
Practice Address - Country:US
Practice Address - Phone:270-789-9216
Practice Address - Fax:270-469-0914
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRI-GENERATIONS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-22
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities