Provider Demographics
NPI:1265610828
Name:BUCKHORN LAKE AREA SUPPORT TEAM, INC
Entity type:Organization
Organization Name:BUCKHORN LAKE AREA SUPPORT TEAM, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BOWLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-216-7438
Mailing Address - Street 1:5053 N KY HIGHWAY 15
Mailing Address - Street 2:
Mailing Address - City:BONNYMAN
Mailing Address - State:KY
Mailing Address - Zip Code:41719-8972
Mailing Address - Country:US
Mailing Address - Phone:606-487-1050
Mailing Address - Fax:606-487-1051
Practice Address - Street 1:5053 N KY HIGHWAY 15
Practice Address - Street 2:
Practice Address - City:BONNYMAN
Practice Address - State:KY
Practice Address - Zip Code:41719-8972
Practice Address - Country:US
Practice Address - Phone:606-487-1050
Practice Address - Fax:606-487-1051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage