MEDICARE: ST. MARY'S CENTER, 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
1	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1669641635
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. MARY'S CENTER, INC.

Provider Business Mailing Address
First Line	:	PO BOX 43443
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40253-0443
Country	:	US
Telephone Number	:	502-254-7298
Fax Number	:

Provider Business Practice Location Address
First Line	:	11700 MAIN ST
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40243-1426
Country	:	US
Telephone Number	:	502-254-7298
Fax Number	:	502-254-7298

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	REGINA BEVELACQUA
Credential	:
Telephone Number	:	502-254-7298

Provider Enumeration Date	:	02/25/2008
Last Update Date	:	02/25/2008

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