Provider Demographics
NPI:1770509770
Name:BOURBON HEIGHTS INC
Entity Type:Organization
Organization Name:BOURBON HEIGHTS INC
Other - Org Name:JOSEPH ALLEN ADULT DAY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-987-5750
Mailing Address - Street 1:2000 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:KY
Mailing Address - Zip Code:40361-1149
Mailing Address - Country:US
Mailing Address - Phone:859-987-5750
Mailing Address - Fax:859-987-6460
Practice Address - Street 1:2000 MAIN ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:KY
Practice Address - Zip Code:40361-1149
Practice Address - Country:US
Practice Address - Phone:859-987-0065
Practice Address - Fax:859-987-6460
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOURBON HEIGHTS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-14
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY750139261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY43000421Medicaid