Healthcare Provider Details

I. General information

NPI: 1588801203
Provider Name (Legal Business Name): MARYHURST, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2009
Last Update Date: 12/02/2022
Certification Date: 12/02/2022
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 Number500032
License Number StateKY

VIII. Authorized Official

Name: MS. PAULA GARNER
Title or Position: PRESIDENT/CEO
Credential:
Phone: 502-245-1576