Organization
KENTUCKY INDEPENDENT CHOICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. FEDELIS BAYENYUO MBUAGBAW (EXECUTIVE DIRECTOR)
(502) 223-2026
Entity
Organization
Contact information
Practice address
312 SAINT CLAIR ST, FRANKFORT, KY 40601-1820
(502) 223-2026
Mailing address
312 SAINT CLAIR ST, FRANKFORT, KY 40601-1820
(502) 223-2026
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
098980
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33001090
—
KY
Enumeration date
01/05/2007
Last updated
08/22/2020
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