Provider Demographics
NPI:1376700187
Name:UNITED CEREBRAL PALSY OF KENTUCKY
Entity Type:Organization
Organization Name:UNITED CEREBRAL PALSY OF KENTUCKY
Other - Org Name:UCP OF KENTUCKY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY & TREASURER OF THE BOARD
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:G
Authorized Official - Last Name:WEEKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-273-3024
Mailing Address - Street 1:9040 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3432
Mailing Address - Country:US
Mailing Address - Phone:305-596-9040
Mailing Address - Fax:305-598-8240
Practice Address - Street 1:9040 SUNSET DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3432
Practice Address - Country:US
Practice Address - Phone:305-596-9040
Practice Address - Fax:305-598-8240
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUNRISE 2000, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY33000548OtherMEDICAID PROVIDER NUMBER