Provider Demographics
NPI:1437317203
Name:CENTRAL KENTUCKY SUPPORTIVE LIVING, INC
Entity Type:Organization
Organization Name:CENTRAL KENTUCKY SUPPORTIVE LIVING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-674-6962
Mailing Address - Street 1:650 PEELED OAK RD
Mailing Address - Street 2:
Mailing Address - City:OWINGSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40360-8047
Mailing Address - Country:US
Mailing Address - Phone:606-674-6962
Mailing Address - Fax:
Practice Address - Street 1:650 PEELED OAK RD
Practice Address - Street 2:
Practice Address - City:OWINGSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40360-8047
Practice Address - Country:US
Practice Address - Phone:606-674-6962
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities