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General NPI Number Information
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NPI Number | 1649866344
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Entity Type | Organization
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Legal Business Name | SHERYL'S HOUSE LLC
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Dates
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Enumeration Date | 12/16/2020
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Last Update Date | 12/16/2020
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Provider Practice Location Address
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Address Line | 4136 WHEELER AVE
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City | LOUISVILLE
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State | KY
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Zip | 40215-1221
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Country | US
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Telephone | 502-619-9622
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Fax |
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Provider Business Mailing Address
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Address Line | 3931 CANE RUN RD
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City | LOUISVILLE
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State | KY
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Zip | 40211-2013
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Country | US
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Telephone | 502-619-9622
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING ADMINISTRATOR
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Name | JACQUELINE SANDERS
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Credential |
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Telephone | 502-630-2036
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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