Provider Demographics
NPI:1841374667
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 4728
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40544-4728
Mailing Address - Country:US
Mailing Address - Phone:859-254-5701
Mailing Address - Fax:859-233-1615
Practice Address - Street 1:85 N GRAND AVENUE
Practice Address - Street 2:ST LUKE HOSPITAL EAST
Practice Address - City:FORT THOMAS
Practice Address - State:KY
Practice Address - Zip Code:41075
Practice Address - Country:US
Practice Address - Phone:859-572-3880
Practice Address - Fax:859-572-3895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY01000306Medicaid
000000327149OtherANTHEM
OH2506069Medicaid
KY50008447Medicaid
KY01000306Medicaid