Healthcare Provider Details

I. General information

NPI: 1609818434
Provider Name (Legal Business Name): ZOOM GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 03/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1904 EMBASSY SQUARE BLVD
LOUISVILLE KY
40299
US

IV. Provider business mailing address

1904 EMBASSY SQUARE BLVD
LOUISVILLE KY
40299
US

V. Phone/Fax

Practice location:
  • Phone: 502-581-0658
  • Fax: 502-581-9520
Mailing address:
  • Phone: 502-581-0658
  • Fax: 502-581-9520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number750120
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number0216571
License Number StateKY

VIII. Authorized Official

Name: JOHN WILSON
Title or Position: QUALITY ASSURANCE MANAGER
Credential:
Phone: 502-581-0658