Healthcare Provider Details

I. General information

NPI: 1548702756
Provider Name (Legal Business Name): PERSONAL OPTIONS HOMECARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2016
Last Update Date: 11/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9311 PONDER LN
LOUISVILLE KY
40272-3921
US

IV. Provider business mailing address

9311 PONDER LN
LOUISVILLE KY
40272-3921
US

V. Phone/Fax

Practice location:
  • Phone: 502-396-3545
  • Fax:
Mailing address:
  • Phone: 502-396-3545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number500249
License Number StateKY

VIII. Authorized Official

Name: MR. MARCUS LEE FORWARD SR.
Title or Position: CEO/FOUNDER
Credential:
Phone: 502-396-3545