Provider Demographics
NPI:1063542538
Name:AREA LIFE CENTER
Entity type:Organization
Organization Name:AREA LIFE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:SPARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-435-0140
Mailing Address - Street 1:PO BOX 1990
Mailing Address - Street 2:257 COMBS RD STE 2
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701
Mailing Address - Country:US
Mailing Address - Phone:606-436-2308
Mailing Address - Fax:606-436-0069
Practice Address - Street 1:257 COMBS RD
Practice Address - Street 2:STE 2
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701
Practice Address - Country:US
Practice Address - Phone:606-436-2308
Practice Address - Fax:606-436-0069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY33001512Medicaid