Provider Demographics
NPI:1598364333
Name:REDWOOD SCHOOL & REHABILITATION CENTER, INC
Entity Type:Organization
Organization Name:REDWOOD SCHOOL & REHABILITATION CENTER, INC
Other - Org Name:EASTERSEALS REDWOOD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-331-0880
Mailing Address - Street 1:71 ORPHANAGE RD
Mailing Address - Street 2:
Mailing Address - City:FORT MITCHELL
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3099
Mailing Address - Country:US
Mailing Address - Phone:859-331-0880
Mailing Address - Fax:855-704-1573
Practice Address - Street 1:71 ORPHANAGE RD
Practice Address - Street 2:
Practice Address - City:FORT MITCHELL
Practice Address - State:KY
Practice Address - Zip Code:41017-3099
Practice Address - Country:US
Practice Address - Phone:859-331-0880
Practice Address - Fax:855-704-1573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-22
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100713640Medicaid