Provider Demographics
NPI:1386704021
Name:LESLIE KNOTT LETCHER PERRY COMMUNITY ACTION COUNCIL
Entity type:Organization
Organization Name:LESLIE KNOTT LETCHER PERRY COMMUNITY ACTION COUNCIL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:DUKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-435-7996
Mailing Address - Street 1:398 ROY CAMPBELL DR
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-9486
Mailing Address - Country:US
Mailing Address - Phone:606-435-7996
Mailing Address - Fax:606-439-1157
Practice Address - Street 1:149 REDBUD LN
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-2052
Practice Address - Country:US
Practice Address - Phone:606-436-8700
Practice Address - Fax:606-436-0500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY750071251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY43000793Medicaid