Healthcare Provider Details

I. General information

NPI: 1477324150
Provider Name (Legal Business Name): 360CARE SERVICES OF KENTUCKY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2024
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12910 SHELBYVILLE RD STE 300
LOUISVILLE KY
40243-2404
US

IV. Provider business mailing address

12910 SHELBYVILLE RD STE 300
LOUISVILLE KY
40243-2404
US

V. Phone/Fax

Practice location:
  • Phone: 248-528-2116
  • Fax: 502-996-8282
Mailing address:
  • Phone: 502-813-4415
  • Fax: 502-996-8282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: JOY L STEVENS
Title or Position: DIRECTOR OF REVENUE
Credential:
Phone: 502-244-2441