Provider Demographics
NPI:1336591510
Name:LAKE CUMBERLAND COMMUNITY ACTION AGENCY, INC.
Entity Type:Organization
Organization Name:LAKE CUMBERLAND COMMUNITY ACTION AGENCY, INC.
Other - Org Name:DUNBAR INTERGENERATIONAL CENTER ADULT DAY HEALTH SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:POLSTON
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:270-343-4600
Mailing Address - Street 1:PO BOX 830
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42629-0830
Mailing Address - Country:US
Mailing Address - Phone:270-343-4600
Mailing Address - Fax:270-343-2800
Practice Address - Street 1:255 S. MAPLE STREET
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501
Practice Address - Country:US
Practice Address - Phone:270-343-4600
Practice Address - Fax:270-343-2800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care