Healthcare Provider Details

I. General information

NPI: 1750181053
Provider Name (Legal Business Name): DAISY'S CARE HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 03/17/2025
Certification Date: 02/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 S 22ND ST
LOUISVILLE KY
40210-2149
US

IV. Provider business mailing address

1815 S 22ND ST
LOUISVILLE KY
40210-2149
US

V. Phone/Fax

Practice location:
  • Phone: 502-224-5690
  • Fax:
Mailing address:
  • Phone: 502-224-5690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name: ANGELITA R CARGILL
Title or Position: OWNER/OPERATOR
Credential:
Phone: 502-224-5690