Healthcare Provider Details

I. General information

NPI: 1306918198
Provider Name (Legal Business Name): TERRADISE PROPERTIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 08/18/2023
Certification Date: 08/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 HUSTONVILLE RD
DANVILLE KY
40422-2137
US

IV. Provider business mailing address

900 HUSTONVILLE RD
DANVILLE KY
40422-2137
US

V. Phone/Fax

Practice location:
  • Phone: 859-238-0002
  • Fax: 859-936-2043
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPO6316
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License NumberPO6316
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPO6316
License Number StateKY

VIII. Authorized Official

Name: DOUG COYLE
Title or Position: OWNER
Credential: R.PH.
Phone: 859-238-0002