Provider Demographics
NPI:1407972094
Name:BAWAC, INC.
Entity Type:Organization
Organization Name:BAWAC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:R
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:MS PSYCHOLOGY
Authorized Official - Phone:859-371-4410
Mailing Address - Street 1:7970 KENTUCKY DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-2915
Mailing Address - Country:US
Mailing Address - Phone:859-371-4410
Mailing Address - Fax:859-371-1726
Practice Address - Street 1:7970 KENTUCKY DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-2915
Practice Address - Country:US
Practice Address - Phone:859-371-4410
Practice Address - Fax:859-371-1726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
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
KY33300088Medicaid