Healthcare Provider Details

I. General information

NPI: 1689109118
Provider Name (Legal Business Name): AMAZING ADULT DAY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2017
Last Update Date: 04/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 S 6TH ST
LOUISVILLE KY
40203-2124
US

IV. Provider business mailing address

3149 COMMERCE CENTER PL
LOUISVILLE KY
40211-1975
US

V. Phone/Fax

Practice location:
  • Phone: 502-774-3337
  • Fax:
Mailing address:
  • Phone: 502-774-3337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number750194
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number750194
License Number StateKY

VIII. Authorized Official

Name: RODNIKA LASHA FLOYD
Title or Position: CEO
Credential:
Phone: 502-598-7402