MEDICARE: HOME OF THE INNOCENTS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM2500X	Medical Specialty Clinic/Center	740143	KY
2	261QD0000X	Dental Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477861888
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOME OF THE INNOCENTS, INC.

Provider Business Mailing Address
First Line	:	1050 E MARKET ST
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40206-1874
Country	:	US
Telephone Number	:	502-596-1090
Fax Number	:	502-596-1410

Provider Business Practice Location Address
First Line	:	1050 E MARKET ST
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40206-1874
Country	:	US
Telephone Number	:	502-596-1090
Fax Number	:	502-596-1410

Authorized Official
Title or Position	:	CREDENTIALING/CONTRACT SPECIALIST
Name	:	LESLIE ANN KAUFMAN
Credential	:
Telephone Number	:	502-596-1048

Provider Enumeration Date	:	09/20/2010
Last Update Date	:	05/15/2025

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Directions to “HOME OF THE INNOCENTS, INC. ” Practice Location

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