Provider Demographics
NPI:1295873032
Name:ACTIVE DAY KY, INC.
Entity type:Organization
Organization Name:ACTIVE DAY KY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHNERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-642-6600
Mailing Address - Street 1:6 NESHAMINY INTERPLEX DR
Mailing Address - Street 2:SUITE 401
Mailing Address - City:TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-6964
Mailing Address - Country:US
Mailing Address - Phone:215-642-6600
Mailing Address - Fax:215-642-6610
Practice Address - Street 1:90 ALEXANDRIA PIKE
Practice Address - Street 2:SUITE 4-7
Practice Address - City:FORT THOMAS
Practice Address - State:KY
Practice Address - Zip Code:41075-4108
Practice Address - Country:US
Practice Address - Phone:859-442-7000
Practice Address - Fax:859-441-6180
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACTIVE DAY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-02
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY261QD1600X
261QR0400X, 261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4300083500Medicaid