Provider Demographics
NPI:1629116413
Name:ASPEN NURSING SERVICES INC
Entity Type:Organization
Organization Name:ASPEN NURSING SERVICES INC
Other - Org Name:ASPEN COMMUNITY LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SONNY
Authorized Official - Middle Name:
Authorized Official - Last Name:KESSEBEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-415-1444
Mailing Address - Street 1:PO BOX 131120
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-0010
Mailing Address - Country:US
Mailing Address - Phone:866-415-1444
Mailing Address - Fax:651-415-1334
Practice Address - Street 1:7000 HOUSTON RD STE 27 BLDG 300
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-4879
Practice Address - Country:US
Practice Address - Phone:859-525-4999
Practice Address - Fax:859-525-4920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33001173251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY33001173Medicaid