Provider Demographics
NPI:1851450464
Name:CEREBRAL PALSY KIDS CENTER INC
Entity Type:Organization
Organization Name:CEREBRAL PALSY KIDS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:
Authorized Official - Last Name:LUTKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-635-6397
Mailing Address - Street 1:982 EASTERN PARKWAY
Mailing Address - Street 2:# 6
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40217-1501
Mailing Address - Country:US
Mailing Address - Phone:502-635-6397
Mailing Address - Fax:502-635-1147
Practice Address - Street 1:982 EASTERN PARKWAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1501
Practice Address - Country:US
Practice Address - Phone:502-635-6397
Practice Address - Fax:502-635-1147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90630567OtherDME MEDICAID
IN200067440AOtherMEDICAID
22000000217778OtherANTHEM BLUE SHIELD ST
22000000217777OtherANTHEM BLUE SHIELD OT
22000000217779OtherANTHEM BLUE SHIELD PT
KY65901993Medicaid
KY50006662OtherPASSPORT MD
KY50000598OtherPASSPORT THERAPY