Healthcare Provider Details

I. General information

NPI: 1487540357
Provider Name (Legal Business Name): MARYHURST INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 06/16/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2108 DAVID GRAVES DRIVE
LOUISVILLE KY
40218
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 Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER WHITE
Title or Position: UM MANAGER
Credential:
Phone: 502-271-4583