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General NPI Number Information
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NPI Number | 1396134540
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Entity Type | Organization
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Legal Business Name | PRIDE HEALTH CARE SERVICE LLC
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Dates
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Enumeration Date | 01/12/2015
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Last Update Date | 01/12/2015
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Provider Practice Location Address
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Address Line | 417 E LEE ST
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City | LOUISVILLE
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State | KY
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Zip | 40217-1139
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Country | US
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Telephone | 502-409-5805
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Fax |
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Provider Business Mailing Address
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Address Line | 417 E LEE ST
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City | LOUISVILLE
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State | KY
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Zip | 40217-1139
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Country | US
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Telephone | 502-409-5805
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. AMANDEEP SINGH
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Credential |
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Telephone | 502-565-4355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 3008170
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License Number State | KY
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