Provider Demographics
NPI:1609921485
Name:NEW AGE ADULT DAY SERVICES
Entity Type:Organization
Organization Name:NEW AGE ADULT DAY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:LISA
Authorized Official - Last Name:LAVERTU-KOTTCAMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-422-7777
Mailing Address - Street 1:2015 BYPASS RD
Mailing Address - Street 2:
Mailing Address - City:BRANDENBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40108-1605
Mailing Address - Country:US
Mailing Address - Phone:270-422-7777
Mailing Address - Fax:270-422-7799
Practice Address - Street 1:2015 BYPASS RD
Practice Address - Street 2:
Practice Address - City:BRANDENBURG
Practice Address - State:KY
Practice Address - Zip Code:40108-1605
Practice Address - Country:US
Practice Address - Phone:270-422-7777
Practice Address - Fax:270-422-7799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY43000348Medicaid