Provider Demographics
NPI:1376616128
Name:OLIVIA CARES FOR KENTUCKY
Entity Type:Organization
Organization Name:OLIVIA CARES FOR KENTUCKY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:HANNON
Authorized Official - Last Name:RAKESTRAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-624-9163
Mailing Address - Street 1:108 AVAWAN DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475
Mailing Address - Country:US
Mailing Address - Phone:859-624-9163
Mailing Address - Fax:859-624-9163
Practice Address - Street 1:108 AVAWAN DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475
Practice Address - Country:US
Practice Address - Phone:859-624-9163
Practice Address - Fax:859-624-9163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities