Organization
LIFETIME POTENTIALS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAY LEE VANOVER (PRESIDENT)
(606) 693-0994
Entity
Organization
Contact information
Practice address
43 LJ LANE, JACKSON, KY 41339
(606) 693-0994
(606) 693-0959
Mailing address
PO BOX 798, JACKSON, KY 41339
(606) 693-0994
(606) 693-0959
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
007700784
KY
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33001256
—
KY
05
—
3300125600
—
KY
05
—
7100179820
—
KY
Enumeration date
02/23/2007
Last updated
10/11/2017
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