Provider Demographics
NPI:1871623520
Name:FERN CREEK TRADITIONAL HIGH SCHOOL
Entity type:Organization
Organization Name:FERN CREEK TRADITIONAL HIGH SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATHLETIC DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:P
Authorized Official - Last Name:AMSHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-538-4951
Mailing Address - Street 1:195 AULBERN DR E
Mailing Address - Street 2:
Mailing Address - City:MT WASHINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40047-6300
Mailing Address - Country:US
Mailing Address - Phone:502-553-0470
Mailing Address - Fax:502-485-8009
Practice Address - Street 1:9115 FERN CREEK RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40291-2711
Practice Address - Country:US
Practice Address - Phone:502-553-0470
Practice Address - Fax:502-485-8009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAT445305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service