Healthcare Provider Details

I. General information

NPI: 1588558597
Provider Name (Legal Business Name): CERES CHILL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2025
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 HURSTBOURNE WOODS DR
LOUISVILLE KY
40299-1370
US

IV. Provider business mailing address

10750 N MADISON AVE NE
BAINBRIDGE ISLAND WA
98110-1372
US

V. Phone/Fax

Practice location:
  • Phone: 859-457-6890
  • Fax:
Mailing address:
  • Phone: 609-504-6756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number
License Number State

VIII. Authorized Official

Name: ERIN GILBERT
Title or Position: EXECUTIVE PROJECT MANAGER
Credential:
Phone: 708-945-8492