Healthcare Provider Details

I. General information

NPI: 1164742482
Provider Name (Legal Business Name): ACCESS ADULT HEALTH DAY CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2010
Last Update Date: 01/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 DUPONT RD
LOUISVILLE KY
40207-4602
US

IV. Provider business mailing address

908 DUPONT RD
LOUISVILLE KY
40207-4602
US

V. Phone/Fax

Practice location:
  • Phone: 502-891-0029
  • Fax: 502-891-0028
Mailing address:
  • Phone: 502-891-0029
  • Fax: 502-891-0028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number3676
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number3676
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code347B00000X
TaxonomyBus
License Number3676
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. SERGE ADAMOV
Title or Position: DIRECTOR
Credential: MBA
Phone: 502-891-0029