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NPI Code Detail

MEDICARE: MARYHURST, INC.

MEDICARE: MARYHURST, INC.
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
1322D00000XEmotionally Disturbed Childrens' Residential Treatment Facility500032KY

General Provider Information

NPI Number : 1588801203
Entity Type Code : Organization
Provider Name (Legal Business Name) : MARYHURST, INC.
Provider Business Mailing Address
First Line : 1015 DORSEY LN
Second Line :
City : LOUISVILLE
State : KY
Zip : 40223-2612
Country : US
Telephone Number : 502-245-1576
Fax Number :
Provider Business Practice Location Address
First Line : 1015 DORSEY LN
Second Line :
City : LOUISVILLE
State : KY
Zip : 40223-2612
Country : US
Telephone Number : 502-245-1576
Fax Number :
Authorized Official
Title or Position : PRESIDENT/CEO
Name : MS. PAULA GARNER
Credential :
Telephone Number : 502-245-1576
Provider Enumeration Date : 01/16/2009
Last Update Date : 12/02/2022

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Directions to “MARYHURST, INC. ” Practice Location

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