Healthcare Provider Details

I. General information

NPI: 1518858935
Provider Name (Legal Business Name): MARYHURST, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2025
Last Update Date: 07/14/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 DORSEY LN
LOUISVILLE KY
40223-2612
US

IV. Provider business mailing address

1015 DORSEY LN
LOUISVILLE KY
40223-2612
US

V. Phone/Fax

Practice location:
  • Phone: 502-245-1576
  • Fax:
Mailing address:
  • Phone: 502-245-1576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: BRITTANY SAPPENFIELD
Title or Position: DIRECTOR OF APQ
Credential:
Phone: 502-271-4678