Healthcare Provider Details

I. General information

NPI: 1467105908
Provider Name (Legal Business Name): SERVING OUR PURPOSE HEALTHCARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2022
Last Update Date: 02/03/2022
Certification Date: 02/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2412 PRESCOTT LN
LEXINGTON KY
40511-2272
US

IV. Provider business mailing address

PO BOX 11792
LEXINGTON KY
40578-1792
US

V. Phone/Fax

Practice location:
  • Phone: 859-420-4515
  • Fax:
Mailing address:
  • Phone: 859-757-1198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JEREMY PHILLIPS
Title or Position: OWNER
Credential:
Phone: 859-420-4515