Healthcare Provider Details

I. General information

NPI: 1710243860
Provider Name (Legal Business Name): GREEN HORSESHOE HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2012
Last Update Date: 04/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2145 W HILL ST
LOUISVILLE KY
40210-1923
US

IV. Provider business mailing address

2145 W HILL ST
LOUISVILLE KY
40210-1923
US

V. Phone/Fax

Practice location:
  • Phone: 502-287-2763
  • Fax:
Mailing address:
  • Phone: 502-287-2763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number StateNULL

VIII. Authorized Official

Name: TIMOTHY NEAL
Title or Position: OWNER
Credential:
Phone: 502-287-2763