Healthcare Provider Details

I. General information

NPI: 1447880232
Provider Name (Legal Business Name): INDEPENDENCE CARE OF KENTUCKY AT LOUISVILLE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2020
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10200 FOREST GREEN BLVD STE 112
LOUISVILLE KY
40223-5167
US

IV. Provider business mailing address

517 W SADDLE RIVER RD
UPPER SADDLE RIVER NJ
07458-1138
US

V. Phone/Fax

Practice location:
  • Phone: 917-733-1135
  • Fax:
Mailing address:
  • Phone: 917-733-1135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name: ALLISON VIAR
Title or Position: OWNER
Credential:
Phone: 917-733-1135