Provider Demographics
NPI:1063703676
Name:COMMUNITY SERVICES OF NORTHERN KENTUCKY
Entity type:Organization
Organization Name:COMMUNITY SERVICES OF NORTHERN KENTUCKY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:CNE, CNC
Authorized Official - Phone:859-525-1128
Mailing Address - Street 1:31 SPIRAL DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-1351
Mailing Address - Country:US
Mailing Address - Phone:859-525-1128
Mailing Address - Fax:859-371-0899
Practice Address - Street 1:31 SPIRAL DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-1351
Practice Address - Country:US
Practice Address - Phone:859-525-1128
Practice Address - Fax:859-371-0899
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE POINT/ARC OF NORTHERN KENTUCKY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-29
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY750164261QA0600X, 343900000X, 344600000X
KY347B00000X
KY751064261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No344600000XTransportation ServicesTaxi
No347B00000XTransportation ServicesBus
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100168480Medicaid
KY7100167570Medicaid
KY7100163590Medicaid
KY7100167590Medicaid
KY7100168500Medicaid