Provider Demographics
NPI:1588962328
Name:GUARDIAN COMMUNITY LIVING - KENTUCKY
Entity type:Organization
Organization Name:GUARDIAN COMMUNITY LIVING - KENTUCKY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:IRELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-377-9140
Mailing Address - Street 1:10503 TIMBERWOOD CIR STE 100
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5318
Mailing Address - Country:US
Mailing Address - Phone:606-260-1275
Mailing Address - Fax:
Practice Address - Street 1:10503 TIMBERWOOD CIR STE 100
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-5318
Practice Address - Country:US
Practice Address - Phone:606-260-1275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-02
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services