Healthcare Provider Details

I. General information

NPI: 1598069478
Provider Name (Legal Business Name): A2002 SENIOR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2011
Last Update Date: 01/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 SPRINGDALE RD
LOUISVILLE KY
40241-6121
US

IV. Provider business mailing address

4501 SPRINGDALE RD
LOUISVILLE KY
40241-6121
US

V. Phone/Fax

Practice location:
  • Phone: 502-412-0222
  • Fax:
Mailing address:
  • Phone: 502-412-0222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: BRYAN HUDSON
Title or Position: GENERAL COUNSEL
Credential:
Phone: 502-779-7683