Healthcare Provider Details

I. General information

NPI: 1366916736
Provider Name (Legal Business Name): KOALA HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2019
Last Update Date: 01/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9850 VON ALLMEN CT STE 201
LOUISVILLE KY
40241-2855
US

IV. Provider business mailing address

9850 VON ALLMEN CT STE 201
LOUISVILLE KY
40241-2855
US

V. Phone/Fax

Practice location:
  • Phone: 502-276-0400
  • Fax:
Mailing address:
  • Phone: 502-276-0400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: FARDOWZA SHEIKH OSMAN
Title or Position: DIRECTOR
Credential:
Phone: 201-300-5241