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COMMONWEALTH OF KENTUCKY

Intermediate Care Facility, Mentally Retarded

Louisville, Kentucky

Provider NPI: 1043298979

Organization Information:
Organization Name:  COMMONWEALTH OF KENTUCKY


Practice Location:
5512 DEL MARIA WAY  LOUISVILLE, KY 40291 US
Tel: 502-361-2301  Fax: --

Business Mailing Address:
  ,   
Tel: --  Fax: --


Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y315P00000XNursing & Custodial Care Facilities
Intermediate Care Facility, Mentally Retarded
KY100694

Other Provider Identifiers:

IssuerNumberStateType
11906070KY05
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin




MENTALLY RETARDED JOBS KY - Page 1



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