Healthcare Provider Details

I. General information

NPI: 1124059860
Provider Name (Legal Business Name): PRINCETON HOME HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 02/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 WALKER CHAPEL PLZ SUITE 345
FULTONDALE AL
35068-3400
US

IV. Provider business mailing address

9510 ORMSBY STATION RD SUITE 300
LOUISVILLE KY
40223-4081
US

V. Phone/Fax

Practice location:
  • Phone: 205-426-7997
  • Fax: 205-426-7727
Mailing address:
  • Phone: 502-891-1000
  • Fax: 502-891-8067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. PATRICK TODD LYLES
Title or Position: SR. V. P., ADMINISTRATION
Credential:
Phone: 502-891-1044