Healthcare Provider Details

I. General information

NPI: 1548874316
Provider Name (Legal Business Name): HARVEST GROVE LTC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2020
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1113 MEDINA RD STE 700
MEDINA OH
44256-9335
US

IV. Provider business mailing address

805 N WHITTINGTON PKWY STE 400
LOUISVILLE KY
40222-7101
US

V. Phone/Fax

Practice location:
  • Phone: 888-322-6216
  • Fax: 800-258-9178
Mailing address:
  • Phone: 502-627-7100
  • Fax: 855-217-7498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ALLISON L. BROWN
Title or Position: SECRETARY
Credential:
Phone: 502-630-7429