Healthcare Provider Details

I. General information

NPI: 1790439743
Provider Name (Legal Business Name): EZR HOME CARE AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2022
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3429 W MARKET ST
LOUISVILLE KY
40212-2349
US

IV. Provider business mailing address

1600 GARLAND AVE APT 703
LOUISVILLE KY
40210-2477
US

V. Phone/Fax

Practice location:
  • Phone: 812-773-2619
  • Fax:
Mailing address:
  • Phone: 502-634-8418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number StateNULL
# 6
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: JACQUELINE SANDERS
Title or Position: CREDENTIALIN MANAGER
Credential:
Phone: 502-974-2130