Healthcare Provider Details

I. General information

NPI: 1912054602
Provider Name (Legal Business Name): YMCA OF GREATER LOUISVILLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 FORDHAVEN RD
LOUISVILLE KY
40214-3960
US

IV. Provider business mailing address

545 S 2ND ST
LOUISVILLE KY
40202-1801
US

V. Phone/Fax

Practice location:
  • Phone: 502-933-9622
  • Fax: 502-933-6309
Mailing address:
  • Phone: 502-587-9622
  • Fax: 502-587-4323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number750124
License Number StateKY

VIII. Authorized Official

Name: MR. STEPHEN TARVER
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 502-587-9622