Provider Demographics
NPI:1780771576
Name:KENTUCKY EASTER SEAL SOCIETY INC
Entity type:Organization
Organization Name:KENTUCKY EASTER SEAL SOCIETY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:GIL
Authorized Official - Last Name:GILLIHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-254-5701
Mailing Address - Street 1:PO BOX 8688
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40533-8688
Mailing Address - Country:US
Mailing Address - Phone:859-254-5701
Mailing Address - Fax:859-233-1615
Practice Address - Street 1:2050 VERSAILLES ROAD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504
Practice Address - Country:US
Practice Address - Phone:859-254-5701
Practice Address - Fax:859-233-1615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY150126251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1213099OtherCHA
KY34000158Medicaid
000000320791OtherANTHEM
KY187176Medicare ID - Type UnspecifiedPALMETTO