Provider Demographics
NPI:1104119239
Name:EXCELLENT SERVICES OF KENTUCKY LLC
Entity type:Organization
Organization Name:EXCELLENT SERVICES OF KENTUCKY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN OF THE BOARD
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:WESTON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:317-557-6430
Mailing Address - Street 1:4965 US HIGHWAY 42
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-6372
Mailing Address - Country:US
Mailing Address - Phone:888-774-0767
Mailing Address - Fax:888-774-8022
Practice Address - Street 1:4965 US HIGHWAY 42
Practice Address - Street 2:SUITE 1000
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-6372
Practice Address - Country:US
Practice Address - Phone:888-774-0767
Practice Address - Fax:888-774-8022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-23
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services