Healthcare Provider Details

I. General information

NPI: 1033536644
Provider Name (Legal Business Name): CARETENDERS VS OF WESTERN KY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2014
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 US HIGHWAY 62 W
PRINCETON KY
42445-6106
US

IV. Provider business mailing address

9510 ORMSBY STATION RD SUITE 300
LOUISVILLE KY
40223-4081
US

V. Phone/Fax

Practice location:
  • Phone: 270-365-2011
  • Fax: 270-365-9433
Mailing address:
  • Phone: 502-891-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA L. PROFFITT
Title or Position: PRESIDENT
Credential:
Phone: 337-233-1307