Provider Demographics
NPI:1275099004
Name:LOGANSLEAGUE DEVELOPMENTAL SERVICES
Entity type:Organization
Organization Name:LOGANSLEAGUE DEVELOPMENTAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DI
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEVALIER
Authorized Official - Suffix:
Authorized Official - Credentials:IECE AND HI TEACHER
Authorized Official - Phone:502-827-1741
Mailing Address - Street 1:1315 LUTHERAN CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-9042
Mailing Address - Country:US
Mailing Address - Phone:502-827-1741
Mailing Address - Fax:
Practice Address - Street 1:1315 LUTHERAN CHURCH RD
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-9042
Practice Address - Country:US
Practice Address - Phone:502-827-1741
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-18
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency