Provider Demographics
NPI:1861244097
Name:POLE HOMESCHOOL SUPPORT GROUP & RESOURCE CENTER, LLC
Entity type:Organization
Organization Name:POLE HOMESCHOOL SUPPORT GROUP & RESOURCE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GENA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:RENO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-702-3983
Mailing Address - Street 1:417 N RICE AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISA
Mailing Address - State:KY
Mailing Address - Zip Code:41230-1250
Mailing Address - Country:US
Mailing Address - Phone:606-638-0032
Mailing Address - Fax:606-638-0032
Practice Address - Street 1:417 N RICE AVE
Practice Address - Street 2:
Practice Address - City:LOUISA
Practice Address - State:KY
Practice Address - Zip Code:41230-1250
Practice Address - Country:US
Practice Address - Phone:606-638-0032
Practice Address - Fax:606-638-0032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty