Provider Demographics
NPI:1376604256
Name:MARSHALL COUNTY ASSN. FOR EXCEPTIONAL CHILDREN AND ADULTS, INC
Entity Type:Organization
Organization Name:MARSHALL COUNTY ASSN. FOR EXCEPTIONAL CHILDREN AND ADULTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JUDI
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1270-527-1327
Mailing Address - Street 1:PO BOX 423
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:KY
Mailing Address - Zip Code:42025-0423
Mailing Address - Country:US
Mailing Address - Phone:127-052-7132
Mailing Address - Fax:127-052-7229
Practice Address - Street 1:198 OLD SYMSONIA ROAD
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:KY
Practice Address - Zip Code:42025
Practice Address - Country:US
Practice Address - Phone:127-052-7132
Practice Address - Fax:127-052-7229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY33300435Medicaid