Healthcare Provider Details

I. General information

NPI: 1609091669
Provider Name (Legal Business Name): CARDIOPULMONARY HOME CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 12/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 ENVOY CIR SUITE 1303
LOUISVILLE KY
40299-2893
US

IV. Provider business mailing address

1300 ENVOY CIR SUITE 1303
LOUISVILLE KY
40299-2893
US

V. Phone/Fax

Practice location:
  • Phone: 502-937-0877
  • Fax: 502-937-0837
Mailing address:
  • Phone: 502-937-0877
  • Fax: 502-937-0837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number StateKY

VIII. Authorized Official

Name: CHERYL H SHONTZ
Title or Position: VICE PRESIDENT
Credential:
Phone: 502-937-0877