Provider Demographics
NPI:1053727610
Name:SHANNON ANSON
Entity type:Organization
Organization Name:SHANNON ANSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TARGET CASE MANAGEMENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:ANSON
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:502-819-6023
Mailing Address - Street 1:3210 SOUTH WINCHESTER ACRES
Mailing Address - Street 2:
Mailing Address - City:LOUSIVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223
Mailing Address - Country:US
Mailing Address - Phone:502-819-6023
Mailing Address - Fax:
Practice Address - Street 1:3001 TAYLOR SPRINGS DRIVE
Practice Address - Street 2:
Practice Address - City:LOUSIVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220
Practice Address - Country:US
Practice Address - Phone:502-819-6023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-03
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY171M0000XMedicaid