Provider Demographics
NPI:1750465571
Name:KENTUCKY EASTER SEAL SOCIETY INC
Entity Type:Organization
Organization Name:KENTUCKY EASTER SEAL SOCIETY INC
Other - Org Name:CARDINAL HILL OF NORTHERN KENTUCKY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT CFO
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:M
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-254-5701
Mailing Address - Street 1:PO BOX 4727
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40544-4727
Mailing Address - Country:US
Mailing Address - Phone:859-254-5701
Mailing Address - Fax:859-233-1615
Practice Address - Street 1:31 SPIRAL DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042
Practice Address - Country:US
Practice Address - Phone:859-525-1128
Practice Address - Fax:859-525-0351
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KENTUCKY EASTER SEAL SOCIETY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-25
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100940261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
7717311OtherAETNA
94OtherFIRST STEPS
000000336625OtherANTHEM PT
000000336653OtherANTHEM OT
000000336691OtherANTHEM ST
94OtherFIRST STEPS