MEDICARE: FULTON HOME CARE SERVICES 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	251J00000X	Nursing Care Agency	150122	KY
2	251E00000X	Home Health Agency	150122	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427051218
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FULTON HOME CARE SERVICES LLC

Provider Business Mailing Address
First Line	:	9510 ORMSBY STATION RD
Second Line	:	STE 300
City	:	LOUISVILLE
State	:	KY
Zip	:	40223-4081
Country	:	US
Telephone Number	:	502-891-1187
Fax Number	:	502-891-8067

Provider Business Practice Location Address
First Line	:	17 CONSTRUCTION RD
Second Line	:	STE F
City	:	MAYFIELD
State	:	KY
Zip	:	42066-6754
Country	:	US
Telephone Number	:	270-247-3155
Fax Number	:	270-247-0803

Authorized Official
Title or Position	:	SR VICE PRESIDENT
Name	:	PATRICK TODD LYLES
Credential	:
Telephone Number	:	502-891-1044

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	01/07/2017

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