MEDICARE: ABODE CARE PARTNERS LTC VB, 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	363A00000X	Physician Assistant
2	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1447029798
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABODE CARE PARTNERS LTC VB, LLC

Provider Business Mailing Address
First Line	:	805 N WHITTINGTON PKWY
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40222-7101
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2529 SIX MILE LN
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40220-2934
Country	:	US
Telephone Number	:	800-807-6555
Fax Number	:	855-316-2999

Authorized Official
Title or Position	:	MGR PROVIDER ENROLLMENT
Name	:	ANGIE MATTINGLY
Credential	:
Telephone Number	:	502-394-2100

Provider Enumeration Date	:	12/28/2023
Last Update Date	:	06/01/2026

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