=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194919548
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HARDIN HOUSING CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2007
-----------------------------------------------------
Last Update Date | 08/29/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2035 S 41ST ST
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-498-3172
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 728 S 45TH STREET
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-498-3172
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | ASTRUN CENTEVUS HARDIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 502-498-3172
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3104A0625X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility (Mental Illness)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------