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General NPI Number Information
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NPI Number | 1962202226
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Entity Type | Organization
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Legal Business Name | SENIOR HAVEN PERSONAL CARE CENTER
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Dates
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Enumeration Date | 03/17/2025
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Last Update Date | 03/17/2025
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Provider Practice Location Address
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Address Line | 1432 AVOCA RIDGE DR
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City | LOUISVILLE
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State | KY
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Zip | 40223-3289
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Country | US
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Telephone | 502-510-9916
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Fax |
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Provider Business Mailing Address
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Address Line | 1432 AVOCA RIDGE DR
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City | LOUISVILLE
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State | KY
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Zip | 40223-3289
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Country | US
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Telephone | 502-510-9916
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. DIAJIAH PHILIDOR
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Credential | RN
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Telephone | 502-616-0376
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251T00000X
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Taxonomy Name | PACE Provider Organization
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License Number |
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License Number State |
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