Healthcare Provider Details

I. General information

NPI: 1063394062
Provider Name (Legal Business Name): SHEPHERD'S HOMECARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5512 HALSTEAD AVE
LOUISVILLE KY
40213-2708
US

IV. Provider business mailing address

312 S 4TH ST STE 700
LOUISVILLE KY
40202-3046
US

V. Phone/Fax

Practice location:
  • Phone: 502-536-8928
  • Fax:
Mailing address:
  • Phone: 502-536-8928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: RIDER ALFONSO PEREZ
Title or Position: OWNER/MANAGER
Credential:
Phone: 502-536-8928