Provider Demographics
NPI:1972646073
Name:BUFFALO TRACE AREA DEVELOPMENT DISTRICT
Entity Type:Organization
Organization Name:BUFFALO TRACE AREA DEVELOPMENT DISTRICT
Other - Org Name:BUFFALO TRACE AREA AGENCY ON AGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF AGING SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:CLARKE
Authorized Official - Last Name:ULLERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-564-6894
Mailing Address - Street 1:PO BOX 460
Mailing Address - Street 2:
Mailing Address - City:MAYSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41056-0460
Mailing Address - Country:US
Mailing Address - Phone:606-564-6894
Mailing Address - Fax:606-564-0955
Practice Address - Street 1:201 GOVERNMENT ST
Practice Address - Street 2:SUITE 300
Practice Address - City:MAYSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41056-1260
Practice Address - Country:US
Practice Address - Phone:606-564-6894
Practice Address - Fax:606-564-0955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY33001413Medicaid
KY43996081Medicaid
KY1700079500Medicaid