Provider Demographics
NPI:1780854034
Name:RANDOM HOUSE COMMUNITY LIVING INC
Entity Type:Organization
Organization Name:RANDOM HOUSE COMMUNITY LIVING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:BOMAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-239-7799
Mailing Address - Street 1:373 WHITFIELD LN
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40071-6300
Mailing Address - Country:US
Mailing Address - Phone:502-239-7799
Mailing Address - Fax:502-239-2809
Practice Address - Street 1:5505 RANDOM WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40291-1821
Practice Address - Country:US
Practice Address - Phone:502-239-7799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health