Provider Demographics
NPI:1376738922
Name:OWENSBORO HABILITATION SERVICES, LLC
Entity type:Organization
Organization Name:OWENSBORO HABILITATION SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:270-302-6538
Mailing Address - Street 1:1620 FREDERICA ST
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-4807
Mailing Address - Country:US
Mailing Address - Phone:270-302-6538
Mailing Address - Fax:
Practice Address - Street 1:1620 FREDERICA ST
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-4807
Practice Address - Country:US
Practice Address - Phone:270-302-6538
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services