Healthcare Provider Details

I. General information

NPI: 1114083086
Provider Name (Legal Business Name): APPLE PATCH COMMUNITY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 02/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7416 HWY 329
CRESTWOOD KY
40014
US

IV. Provider business mailing address

7408 HWY 329
CRESTWOOD KY
40014
US

V. Phone/Fax

Practice location:
  • Phone: 502-657-0103
  • Fax: 502-657-0107
Mailing address:
  • Phone: 502-657-0103
  • Fax: 502-657-0107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number850067
License Number StateKY

VIII. Authorized Official

Name: JOE SPOELKER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 502-657-0103