NPIMap

Organization Active NPI

Northern Kentucky Consumer Directed Options Program

  • Supports Brokerage Agency
  • Florence, KY
National Provider Identifier
1104958370
Registry record updated Apr 22, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Supports Brokerage AgencyTaxonomy code 251X00000X
Legal business name
NORTHERN KENTUCKY CONSUMER DIRECTED OPTIONS PROGRAM
Practice address
22 Spiral Dr
Florence, KY 41042-1300
Phone
(859) 283-1885
Fax
(859) 283-8178
NPI assigned
Mar 12, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Larry Bosley
Title
Finance Officer
Phone
(859) 283-1885

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Supports Brokerage Agency 251X00000X Primary

Addresses

Primary practice location

22 Spiral Dr
Florence, KY 41042-1300

Mailing address

22 Spiral Dr
Florence, KY 41042-1300
Phone (859) 283-1885

Other identifiers 1

IdentifierTypeStateIssuer
43996073MedicaidKY

National Provider Directory

National Provider Directory
Tax ID family
Northern Kentucky Consumer Directed Option Program3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173657600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429660800000",
    "number": "1104958370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 SPIRAL DR",
            "city": "FLORENCE",
            "state": "KY",
            "postal_code": "410421300",
            "telephone_number": "859-283-1885",
            "fax_number": "859-283-8178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 SPIRAL DR",
            "city": "FLORENCE",
            "state": "KY",
            "postal_code": "410421300",
            "telephone_number": "859-283-1885",
            "fax_number": "859-283-8178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN KENTUCKY CONSUMER DIRECTED OPTIONS PROGRAM",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-12",
        "last_updated": "2015-04-22",
        "status": "A",
        "authorized_official_last_name": "BOSLEY",
        "authorized_official_first_name": "LARRY",
        "authorized_official_title_or_position": "FINANCE OFFICER",
        "authorized_official_telephone_number": "859-283-1885",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251X00000X",
            "taxonomy_group": "",
            "desc": "Supports Brokerage",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43996073",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Florence, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.