Healthcare Provider Details

I. General information

NPI: 1710027453
Provider Name (Legal Business Name): HARBOR HOUSE OF LOUISVILLE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 05/06/2021
Certification Date: 05/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2231 LOWER HUNTERS TRCE
LOUISVILLE KY
40216-1358
US

IV. Provider business mailing address

PO BOX 58219
LOUISVILLE KY
40268-0219
US

V. Phone/Fax

Practice location:
  • Phone: 502-719-0072
  • Fax: 502-719-0078
Mailing address:
  • Phone: 502-719-0072
  • Fax: 502-719-0078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number900678
License Number StateKY
# 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 Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: CATHERINE LEE
Title or Position: TRAINING AND COMPLIANCE COORDINATOR
Credential:
Phone: 502-719-0072