Healthcare Provider Details

I. General information

NPI: 1073102786
Provider Name (Legal Business Name): ZORA'S CRADLE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2021
Last Update Date: 01/16/2021
Certification Date: 01/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6844 BARDSTOWN RD # 838
LOUISVILLE KY
40291-3050
US

IV. Provider business mailing address

6844 BARDSTOWN RD # 838
LOUISVILLE KY
40291-3050
US

V. Phone/Fax

Practice location:
  • Phone: 502-830-9460
  • Fax:
Mailing address:
  • Phone: 502-830-9460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SHEMIKA WHITESIDE
Title or Position: EXECUTIVE DIRECTOR
Credential: MSSW, CSW
Phone: 502-830-9460