Healthcare Provider Details

I. General information

NPI: 1518954114
Provider Name (Legal Business Name): MERCY SACRED HEART, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 09/06/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 PAYNE ST
LOUISVILLE KY
40206-2012
US

IV. Provider business mailing address

2120 PAYNE ST
LOUISVILLE KY
40206-2012
US

V. Phone/Fax

Practice location:
  • Phone: 502-895-9425
  • Fax: 502-894-9619
Mailing address:
  • Phone: 502-895-9425
  • Fax: 502-894-9619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number100248
License Number StateKY

VIII. Authorized Official

Name: MR. WILLIAM ROBERT LEE
Title or Position: CFO
Credential: CPA
Phone: 502-357-5534