Provider Demographics
NPI:1992064075
Name:GUARDIAN COMMUNITY LIVING-KENTUCKY, LLC
Entity type:Organization
Organization Name:GUARDIAN COMMUNITY LIVING-KENTUCKY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
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
Mailing Address - Street 2:116
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5318
Mailing Address - Country:US
Mailing Address - Phone:502-429-8003
Mailing Address - Fax:502-429-8045
Practice Address - Street 1:10503 TIMBERWOOD CIR
Practice Address - Street 2:116
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-5318
Practice Address - Country:US
Practice Address - Phone:502-429-8003
Practice Address - Fax:502-429-8043
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GUARDIAN GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities