Healthcare Provider Details

I. General information

NPI: 1912089863
Provider Name (Legal Business Name): HOME OF THE INNOCENTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 08/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 E. MARKET ST.
LOUISVILLE KY
40206
US

IV. Provider business mailing address

1100 E. MARKET ST.
LOUISVILLE KY
40206
US

V. Phone/Fax

Practice location:
  • Phone: 502-596-1000
  • Fax: 502-596-1413
Mailing address:
  • Phone: 502-596-1000
  • Fax: 502-596-1413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number500050
License Number StateKY

VIII. Authorized Official

Name: GORDON BROWN
Title or Position: PRESIDENT & CEO
Credential:
Phone: 502-596-1000