MEDICARE: SHERYL'S HOUSE LLC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1649866344
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHERYL'S HOUSE LLC

Provider Business Mailing Address
First Line	:	3931 CANE RUN RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40211-2013
Country	:	US
Telephone Number	:	502-619-9622
Fax Number	:

Provider Business Practice Location Address
First Line	:	4136 WHEELER AVE
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40215-1221
Country	:	US
Telephone Number	:	502-619-9622
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING ADMINISTRATOR
Name	:	JACQUELINE SANDERS
Credential	:
Telephone Number	:	502-630-2036

Provider Enumeration Date	:	12/16/2020
Last Update Date	:	12/16/2020

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Directions to “SHERYL'S HOUSE LLC ” Practice Location

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