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General NPI Number Information
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NPI Number | 1124015805
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Entity Type | Organization
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Legal Business Name | PRESBYTERIAN HOMES AND SERVICES OF KENTUCKY, INC
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Dates
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Enumeration Date | 09/29/2005
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 2116 BUECHEL BANK RD
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City | LOUISVILLE
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State | KY
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Zip | 40218-3521
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Country | US
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Telephone | 502-259-9101
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Fax | 502-259-9109
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Provider Business Mailing Address
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Address Line | PO BOX 18067
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City | LOUISVILLE
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State | KY
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Zip | 40261-0067
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Country | US
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Telephone | 502-259-9101
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Fax | 502-259-9109
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | HATTIE WAGNER
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Credential |
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Telephone | 502-259-9101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | 101046
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 100242
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License Number State | KY
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