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General NPI Number Information
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NPI Number | 1023925732
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Entity Type | Organization
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Legal Business Name | ATHENA ADVANCE CARE LLC
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Dates
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Enumeration Date | 08/26/2026
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Last Update Date | 08/26/2026
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Provider Practice Location Address
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Address Line | 5301 S 3RD ST STE 101B
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City | LOUISVILLE
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State | KY
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Zip | 40214-2611
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Country | US
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Telephone | 719-654-4997
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Fax | 502-362-1367
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Provider Business Mailing Address
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Address Line | 5301 S 3RD ST STE 101B
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City | LOUISVILLE
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State | KY
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Zip | 40214-2611
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Country | US
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Telephone | 719-654-4997
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Fax | 502-362-1367
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Authorized Official
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Title or Position | PD
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Name | ALEXIS URQUIZA
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Credential | NONE
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Telephone | 719-654-4997
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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