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General NPI Number Information
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NPI Number | 1417592536
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Entity Type | Organization
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Legal Business Name | 360CARE LLC
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Dates
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Enumeration Date | 11/12/2019
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Last Update Date | 02/05/2020
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Provider Practice Location Address
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Address Line | 12910 SHELBYVILLE RD STE 300
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City | LOUISVILLE
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State | KY
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Zip | 40243-2404
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Country | US
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Telephone | 502-244-2441
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Fax | 502-996-8282
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Provider Business Mailing Address
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Address Line | 12910 SHELBYVILLE RD STE 128
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City | LOUISVILLE
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State | KY
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Zip | 40243-1536
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Country | US
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Telephone | 502-244-2441
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Fax | 502-996-8282
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Authorized Official
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Title or Position | MANAGER
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Name | RANDY AMMON
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Credential |
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Telephone | 502-244-2440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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