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General NPI Number Information
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NPI Number | 1104637875
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Entity Type | Organization
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Legal Business Name | CHA HMO, INC.
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Dates
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Enumeration Date | 01/14/2025
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 500 W MAIN ST
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City | LOUISVILLE
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State | KY
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Zip | 40202-4268
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Country | US
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Telephone | 502-580-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 500 W MAIN ST
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City | LOUISVILLE
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State | KY
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Zip | 40202-4268
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Country | US
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Telephone | 502-580-1000
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. GEORGE RENAUDIN
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Credential |
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Telephone | 615-370-1801
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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