Healthcare Provider Details

I. General information

NPI: 1205524287
Provider Name (Legal Business Name): UNIFIED OF LOUISVILLE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2023
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 HEAFER FARM LN UNIT 203
LOUISVILLE KY
40219-7033
US

IV. Provider business mailing address

5400 HEAFER FARM LN UNIT 203
LOUISVILLE KY
40219-7033
US

V. Phone/Fax

Practice location:
  • Phone: 502-533-3340
  • Fax:
Mailing address:
  • Phone: 502-533-3340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: HEATHER PAYNTER
Title or Position: OWNER & CEO
Credential:
Phone: 502-533-3340