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General NPI Number Information
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NPI Number | 1912054602
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Entity Type | Organization
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Legal Business Name | YMCA OF GREATER LOUISVILLE
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 06/30/2008
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Provider Practice Location Address
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Address Line | 2800 FORDHAVEN RD
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City | LOUISVILLE
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State | KY
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Zip | 40214-3960
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Country | US
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Telephone | 502-933-9622
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Fax | 502-933-6309
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Provider Business Mailing Address
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Address Line | 545 S 2ND ST
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City | LOUISVILLE
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State | KY
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Zip | 40202-1801
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Country | US
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Telephone | 502-587-9622
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Fax | 502-587-4323
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | MR. STEPHEN TARVER
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Credential |
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Telephone | 502-587-9622
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | 750124
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License Number State | KY
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