Provider Demographics
NPI:1902684160
Name:KENTUCKY PREMIER PERSONAL CARE
Entity Type:Organization
Organization Name:KENTUCKY PREMIER PERSONAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOAN
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:606-308-7187
Mailing Address - Street 1:157 FISH POND RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:KY
Mailing Address - Zip Code:40460-8708
Mailing Address - Country:US
Mailing Address - Phone:606-392-5343
Mailing Address - Fax:606-770-6091
Practice Address - Street 1:157 FISH POND RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:KY
Practice Address - Zip Code:40460-8708
Practice Address - Country:US
Practice Address - Phone:606-392-5343
Practice Address - Fax:606-770-6091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-19
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care