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General NPI Number Information
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NPI Number | 1245375682
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Entity Type | Organization
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Legal Business Name | SOUTH LOUISVILLE COMMUNITY MINISTRIES ADULT DAY CENTER
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 04/28/2008
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Provider Practice Location Address
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Address Line | 4100 SOUTHERN PKWY
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City | LOUISVILLE
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State | KY
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Zip | 40214-1648
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Country | US
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Telephone | 502-368-7989
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Fax | 502-368-9212
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Provider Business Mailing Address
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Address Line | 4100 SOUTHERN PKWY
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City | LOUISVILLE
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State | KY
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Zip | 40214-1648
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Country | US
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Telephone | 502-368-7989
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Fax | 502-368-9212
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. MICHAEL JUPIN
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Credential |
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Telephone | 502-368-7989
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 9695602
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License Number State | KY
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