Provider Demographics
NPI:1598113102
Name:NDT CARE SERVICES, LLC
Entity Type:Organization
Organization Name:NDT CARE SERVICES, LLC
Other - Org Name:HOMEPLACE SUPPORT SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:BARROWMAN
Authorized Official - Last Name:CLEVENGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-936-2010
Mailing Address - Street 1:PO BOX 24588
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40524-4588
Mailing Address - Country:US
Mailing Address - Phone:859-936-2010
Mailing Address - Fax:859-936-2099
Practice Address - Street 1:2647 REGENCY RD
Practice Address - Street 2:#105
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2959
Practice Address - Country:US
Practice Address - Phone:859-936-2010
Practice Address - Fax:859-936-2099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY33000720Medicaid
KY7100156330Medicaid
KY7100216880Medicaid