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NPI Code Detail

MEDICARE: NORTHEAST JOINT VENTURE, LLC

MEDICARE: NORTHEAST JOINT VENTURE, 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
1282N00000XGeneral Acute Care Hospital

General Provider Information

NPI Number : 1669420063
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTHEAST JOINT VENTURE, LLC
Provider Business Mailing Address
First Line : 1025 NEW MOODY LN
Second Line :
City : LA GRANGE
State : KY
Zip : 40031-9154
Country : US
Telephone Number : 502-222-3316
Fax Number : 502-222-3411
Provider Business Practice Location Address
First Line : 1025 NEW MOODY LN
Second Line :
City : LA GRANGE
State : KY
Zip : 40031-9154
Country : US
Telephone Number : 502-222-3316
Fax Number : 502-222-3411
Authorized Official
Title or Position : PRESIDENT
Name : MR. DENNIS B. JOHNSON
Credential :
Telephone Number : 502-222-3316
Provider Enumeration Date : 05/05/2006
Last Update Date : 08/22/2020

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Directions to “NORTHEAST JOINT VENTURE, LLC ” Practice Location

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