Healthcare Provider Details

I. General information

NPI: 1437976750
Provider Name (Legal Business Name): MASONIC HOMES OF LOUISVILLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2024
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 MASONIC HOME DR
MASONIC HOME KY
40041-9000
US

IV. Provider business mailing address

240 MASONIC HOME DR
MASONIC HOME KY
40041-9000
US

V. Phone/Fax

Practice location:
  • Phone: 502-897-4907
  • Fax: 502-897-8714
Mailing address:
  • Phone: 502-897-4907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: KATHLEEN RENEE BITAR
Title or Position: CORP DIRECTOR OF BILLING & REIMB
Credential:
Phone: 502-753-8331