Organization
IMPACTLEX, LLC
Active
Other names
Cascades of Bluegrass
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL K POTTER (MEMBER)
(859) 489-9287
Entity
Organization
Contact information
Practice address
500 HORTON CT, LEXINGTON, KY 40511-1075
(859) 276-0481
(972) 616-6144
Mailing address
500 HORTON CT, LEXINGTON, KY 40511-1075
(859) 276-0481
(972) 616-6144
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7100056370
MEDICAID PROVIDER NUMBER
KY
Enumeration date
02/12/2019
Last updated
02/12/2019
Update your record
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