Provider Demographics
NPI:1063561702
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 1:9810 BLUEGRASS PARKWAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299
Mailing Address - Country:US
Mailing Address - Phone:502-584-9781
Mailing Address - Fax:502-589-2409
Practice Address - Street 1:9810 BLUEGRASS PARKWAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299
Practice Address - Country:US
Practice Address - Phone:502-584-9781
Practice Address - Fax:502-589-2409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100501261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000387196OtherANTHEM AUDIO
000000342656OtherANTHEM ST
000000342700OtherANTHEM PT
20OtherFIRST STEPS
000000342793OtherANTHEM OT