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General NPI Number Information
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NPI Number | 1346312824
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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 | 11/14/2006
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Last Update Date | 10/26/2011
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Provider Practice Location 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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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 | CHIEF FINANCIAL OFFICER
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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 | 100467
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License Number State | KY
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