Healthcare Provider Details

I. General information

NPI: 1316031305
Provider Name (Legal Business Name): UNIVERSITY OF LOUISVILLE RESEARCH FOUNDATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 03/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 S FLOYD ST
LOUISVILLE KY
40202-3801
US

IV. Provider business mailing address

555 S FLOYD ST
LOUISVILLE KY
40202-3801
US

V. Phone/Fax

Practice location:
  • Phone: 502-852-5588
  • Fax: 502-852-5630
Mailing address:
  • Phone: 502-852-5588
  • Fax: 502-852-5630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MARY KENNEDY
Title or Position: SPEECH LANGUAGE PATHOLOGIST
Credential: SLP
Phone: 502-852-5588