Provider Demographics
NPI:1831234483
Name:ACTIVE DAY KY, INC.
Entity type:Organization
Organization Name:ACTIVE DAY KY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN, CEO, 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 1:3403 BRECKENRIDGE LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-3101
Practice Address - Country:US
Practice Address - Phone:502-896-1444
Practice Address - Fax:502-893-0095
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACTIVE DAY INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-21
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY186641Medicare Oscar/Certification