Provider Demographics
NPI:1871079947
Name:GUIDED LIVING LLC
Entity type:Organization
Organization Name:GUIDED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER /OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:OLEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BURGESS
Authorized Official - Suffix:III
Authorized Official - Credentials:BA
Authorized Official - Phone:606-393-4355
Mailing Address - Street 1:PO BOX 623
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-0623
Mailing Address - Country:US
Mailing Address - Phone:606-393-4355
Mailing Address - Fax:606-393-4356
Practice Address - Street 1:2826 HOLT ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-3967
Practice Address - Country:US
Practice Address - Phone:606-393-4355
Practice Address - Fax:606-393-4356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services