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NPI Code Detail

MEDICARE: KOALA HOME CARE, LLC

MEDICARE: KOALA HOME CARE, 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
1253Z00000XIn Home Supportive Care Agency

General Provider Information

NPI Number : 1366916736
Entity Type Code : Organization
Provider Name (Legal Business Name) : KOALA HOME CARE, LLC
Provider Business Mailing Address
First Line : 9850 VON ALLMEN CT STE 201
Second Line :
City : LOUISVILLE
State : KY
Zip : 40241-2855
Country : US
Telephone Number : 502-276-0400
Fax Number :
Provider Business Practice Location Address
First Line : 9850 VON ALLMEN CT STE 201
Second Line :
City : LOUISVILLE
State : KY
Zip : 40241-2855
Country : US
Telephone Number : 502-276-0400
Fax Number :
Authorized Official
Title or Position : DIRECTOR
Name : FARDOWZA SHEIKH OSMAN
Credential :
Telephone Number : 201-300-5241
Provider Enumeration Date : 01/18/2019
Last Update Date : 01/18/2019

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Directions to “KOALA HOME CARE, LLC ” Practice Location

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