Provider Demographics
NPI:1962540864
Name:ACSR, INC.
Entity type:Organization
Organization Name:ACSR, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:W
Authorized Official - Last Name:BALDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-548-2201
Mailing Address - Street 1:400 REDLAND CT
Mailing Address - Street 2:SUITE 114
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-3270
Mailing Address - Country:US
Mailing Address - Phone:443-548-2200
Mailing Address - Fax:443-548-2260
Practice Address - Street 1:3795 POPLAR LEVEL RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40213-1044
Practice Address - Country:US
Practice Address - Phone:502-479-8802
Practice Address - Fax:502-479-8804
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACTIVE DAY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-02
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4301456200Medicaid
KY3300096900Medicaid