Provider Demographics
NPI:1831197953
Name:COMMISSION FOR CHILDREN WITH SPECIAL HEALTH CAR
Entity type:Organization
Organization Name:COMMISSION FOR CHILDREN WITH SPECIAL HEALTH CAR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BRANCH MANGER PROVIDER RELATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-429-4430
Mailing Address - Street 1:310 WHITTINGTON PKWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222
Mailing Address - Country:US
Mailing Address - Phone:502-429-4430
Mailing Address - Fax:502-429-7160
Practice Address - Street 1:310 WHITTINGTON PKWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222
Practice Address - Country:US
Practice Address - Phone:502-429-4430
Practice Address - Fax:502-429-7160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY22905616Medicaid
KY50000978OtherPASSPORT ETOWN
KY50001443OtherPASSPORT
KY000000061465OtherBLUE CROSS AND BLUE SHIEL