MEDICARE: CHRISTIAN CARE AT HOME - PENNYROYAL, LIMITED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency	150138	KY
2	251E00000X	Home Health Agency	750182	KY

General Provider Information

NPI Number	:	1124375092
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRISTIAN CARE AT HOME - PENNYROYAL, LIMITED

Provider Business Mailing Address
First Line	:	12710 TOWNEPARK WAY
Second Line	:	SUITE 1000
City	:	LOUISVILLE
State	:	KY
Zip	:	40243-2534
Country	:	US
Telephone Number	:	502-254-4200
Fax Number	:	502-254-4209

Provider Business Practice Location Address
First Line	:	122 W UNION ST
Second Line	:
City	:	HARTFORD
State	:	KY
Zip	:	42347-1416
Country	:	US
Telephone Number	:	270-298-3112
Fax Number	:	270-298-4766

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	DR. KEITH R. KNAPP
Credential	:	PHD
Telephone Number	:	502-254-4200

Provider Enumeration Date	:	08/10/2012
Last Update Date	:	09/17/2015

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