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NPI Code Detail

MEDICARE: NAZARETH HOME, INC.

MEDICARE: NAZARETH HOME, 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
1261QA0600XAdult Day Care Clinic/Center

Other Identifiers

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

General Provider Information

NPI Number : 1720446479
Entity Type Code : Organization
Provider Name (Legal Business Name) : NAZARETH HOME, INC.
Provider Business Mailing Address
First Line : 2000 NEWBURG RD
Second Line :
City : LOUISVILLE
State : KY
Zip : 40205-1803
Country : US
Telephone Number : 502-459-9681
Fax Number : 502-456-9077
Provider Business Practice Location Address
First Line : 2120 PAYNE ST
Second Line :
City : LOUISVILLE
State : KY
Zip : 40206-2012
Country : US
Telephone Number : 502-895-9425
Fax Number : 502-357-5549
Authorized Official
Title or Position : CFO
Name : MR. KEVIN J WHEATLEY
Credential : CPA
Telephone Number : 502-459-9681
Provider Enumeration Date : 02/09/2016
Last Update Date : 02/09/2016

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Directions to “NAZARETH HOME, INC. ” Practice Location

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