Provider Demographics
NPI:1881649507
Name:H2 REHABILITATION SERVICES OF KENTUCKY, LLC
Entity Type:Organization
Organization Name:H2 REHABILITATION SERVICES OF KENTUCKY, LLC
Other - Org Name:H2 HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:STREETER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-699-9395
Mailing Address - Street 1:PO BOX 932184
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-2184
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:649 MEYERS BAKER RD
Practice Address - Street 2:SUITE 102
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-3006
Practice Address - Country:US
Practice Address - Phone:606-864-7316
Practice Address - Fax:606-878-0590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
KY100843261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100053830Medicaid
KY87900726Medicaid
KY87900726Medicaid