Provider Demographics
NPI:1063579233
Name:HIGHLANDS COMMUNITY MINISTRIES SENIOR SERVICES ADULT DAY HEALTH CENT
Entity type:Organization
Organization Name:HIGHLANDS COMMUNITY MINISTRIES SENIOR SERVICES ADULT DAY HEALTH CENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY LYNNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MASTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-459-4887
Mailing Address - Street 1:2000 DOUGLASS BLVD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-1928
Mailing Address - Country:US
Mailing Address - Phone:502-459-4887
Mailing Address - Fax:502-452-1484
Practice Address - Street 1:2000 DOUGLASS BLVD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-1928
Practice Address - Country:US
Practice Address - Phone:502-459-4887
Practice Address - Fax:502-452-1484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY750003261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY43001569Medicaid