Healthcare Provider Details

I. General information

NPI: 1730694266
Provider Name (Legal Business Name): ORCHID HOUSE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2017
Last Update Date: 09/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 S 31ST ST
LOUISVILLE KY
40211
US

IV. Provider business mailing address

703 S 31ST ST
LOUISVILLE KY
40211-1410
US

V. Phone/Fax

Practice location:
  • Phone: 502-290-2421
  • Fax: 502-290-3779
Mailing address:
  • Phone: 502-290-2421
  • Fax: 502-290-3779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License Number
License Number StateKY

VIII. Authorized Official

Name: KAITLIN M BLESSITT
Title or Position: EXECUTIVE DIRECTOR
Credential: MSN
Phone: 502-744-9111