Provider Demographics
NPI:1316082407
Name:DEPARTMENT FOR AGING AND INDEPENDENT LIVING
Entity type:Organization
Organization Name:DEPARTMENT FOR AGING AND INDEPENDENT LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMMISSIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:S
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-564-6930
Mailing Address - Street 1:275 EAST MAIN STREET 3WF
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40621
Mailing Address - Country:US
Mailing Address - Phone:502-564-6930
Mailing Address - Fax:502-564-4595
Practice Address - Street 1:275 EAST MAIN 3WF
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40621
Practice Address - Country:US
Practice Address - Phone:502-564-6930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1700087800Medicaid