Provider Demographics
NPI: | 1790139400 |
---|---|
Name: | ACCESS COMMUNITY ASSISTANCE, INC. |
Entity Type: | Organization |
Organization Name: | ACCESS COMMUNITY ASSISTANCE, INC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER/EXECUTIVE DIRECTOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | SUSAN |
Authorized Official - Middle Name: | B |
Authorized Official - Last Name: | STOKES |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 502-899-7105 |
Mailing Address - Street 1: | 159 SAINT MATTHEWS AVE |
Mailing Address - Street 2: | SUITE 9 |
Mailing Address - City: | LOUISVILLE |
Mailing Address - State: | KY |
Mailing Address - Zip Code: | 40207-3137 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 502-899-7105 |
Mailing Address - Fax: | 502-899-1403 |
Practice Address - Street 1: | 159 SAINT MATTHEWS AVE |
Practice Address - Street 2: | SUITE 9 |
Practice Address - City: | LOUISVILLE |
Practice Address - State: | KY |
Practice Address - Zip Code: | 40207-3137 |
Practice Address - Country: | US |
Practice Address - Phone: | 502-899-7105 |
Practice Address - Fax: | 502-899-1403 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2016-04-19 |
Last Update Date: | 2016-09-14 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty | |
No | 224Z00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | Group - Multi-Specialty | |
No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
No | 225XF0002X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Feeding, Eating & Swallowing | Group - Multi-Specialty |
No | 225XM0800X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Mental Health | Group - Multi-Specialty |
No | 225XN1300X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Neurorehabilitation | Group - Multi-Specialty |
No | 225XR0403X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Driving and Community Mobility | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
KY | 17000894 | Medicaid | |
KY | 7100000320 | Medicaid |