Healthcare Provider Details

I. General information

NPI: 1609092113
Provider Name (Legal Business Name): PRESBYTERIAN HOMES AND SERVICES OF KENTUCKY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 11/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2116 BUECHEL BANK RD
LOUISVILLE KY
40218-3521
US

IV. Provider business mailing address

PO BOX 18067
LOUISVILLE KY
40261-0067
US

V. Phone/Fax

Practice location:
  • Phone: 502-499-9383
  • Fax:
Mailing address:
  • Phone: 502-499-9383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number004650
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberR1071
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberR3513
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2655
License Number StateKY
# 5
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number101046
License Number StateKY

VIII. Authorized Official

Name: HATTIE WAGNER
Title or Position: PRESIDENT / CEO
Credential:
Phone: 502-259-9101