Healthcare Provider Details

I. General information

NPI: 1437587987
Provider Name (Legal Business Name): HEALTHY LIFE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2013
Last Update Date: 11/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4229 BARDSTOWN RD STE 320
LOUISVILLE KY
40218-3281
US

IV. Provider business mailing address

4229 BARDSTOWN RD STE 320
LOUISVILLE KY
40218-3281
US

V. Phone/Fax

Practice location:
  • Phone: 502-491-8073
  • Fax: 502-491-8773
Mailing address:
  • Phone: 502-491-8073
  • Fax: 502-491-8773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number39868
License Number StateKY

VIII. Authorized Official

Name: DENNIS E CLAUSE
Title or Position: PRESIDENT
Credential: D.C
Phone: 502-491-8073