MEDICARE: GREEN LEAVES ADHC LLC

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	251E00000X	Home Health Agency
2	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1205547080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREEN LEAVES ADHC LLC

Provider Business Mailing Address
First Line	:	129 SAINT MATTHEWS AVE STE B
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-3141
Country	:	US
Telephone Number	:	502-797-8055
Fax Number	:

Provider Business Practice Location Address
First Line	:	129 SAINT MATTHEWS AVE
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-3141
Country	:	US
Telephone Number	:	502-797-8055
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	SHERRY ERNST
Credential	:
Telephone Number	:	502-260-9271

Provider Enumeration Date	:	12/12/2022
Last Update Date	:	11/17/2025

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