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General NPI Number Information
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NPI Number | 1205292893
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Entity Type | Organization
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Legal Business Name | NAZARETH HOME, INC.
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Dates
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Enumeration Date | 01/12/2016
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Last Update Date | 01/12/2016
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Provider Practice Location Address
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Address Line | 2120 PAYNE ST
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City | LOUISVILLE
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State | KY
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Zip | 40206-2012
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Country | US
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Telephone | 502-595-9425
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Fax | 502-357-5549
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Provider Business Mailing Address
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Address Line | 2000 NEWBURG RD
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City | LOUISVILLE
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State | KY
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Zip | 40205-1803
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Country | US
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Telephone | 502-459-9681
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Fax | 502-456-9077
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Authorized Official
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Title or Position | CFO
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Name | MR. KEVIN WHEATLEY
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Credential | CPA
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Telephone | 502-459-9681
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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