Provider Demographics
NPI:1104966357
Name:ARC OF OWENSBORO
Entity type:Organization
Organization Name:ARC OF OWENSBORO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:D
Authorized Official - Last Name:CONDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-645-5004
Mailing Address - Street 1:PO BOX 1833
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42302-1833
Mailing Address - Country:US
Mailing Address - Phone:270-645-5004
Mailing Address - Fax:270-685-2036
Practice Address - Street 1:1101 E BYERS AVE
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303
Practice Address - Country:US
Practice Address - Phone:270-645-5004
Practice Address - Fax:270-685-2036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X
KY261QM0855X, 251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY33300286Medicaid