Provider Demographics
NPI:1720199268
Name:MATTINGLY CENTER, INC
Entity Type:Organization
Organization Name:MATTINGLY CENTER, INC
Other - Org Name:CEREBRAL PALSY SCHOOL OF LOUISVILLE, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:Q
Authorized Official - Last Name:HENCHEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-451-6200
Mailing Address - Street 1:1520 BAXTER AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-1009
Mailing Address - Country:US
Mailing Address - Phone:502-451-6200
Mailing Address - Fax:502-451-6861
Practice Address - Street 1:1520 BAXTER AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-1009
Practice Address - Country:US
Practice Address - Phone:502-451-6200
Practice Address - Fax:502-451-6861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY750034251C00000X, 261QA0600X, 261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY43003565Medicaid
KY7100060340Medicaid
KY33300260Medicaid