MEDICARE: ELDERCLUB ADC ELDERSERVE 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	261QA0600X	Adult Day Care Clinic/Center	750118	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

General Provider Information

NPI Number	:	1720133200
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELDERCLUB ADC ELDERSERVE INC.

Provider Business Mailing Address
First Line	:	631 S 28TH ST
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40211-1369
Country	:	US
Telephone Number	:	502-776-3066
Fax Number	:

Provider Business Practice Location Address
First Line	:	631 S 28TH ST
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40211-1369
Country	:	US
Telephone Number	:	502-776-3066
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF THE ADC
Name	:	MR. HAROLD D JONES
Credential	:
Telephone Number	:	502-776-3066

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	08/22/2020

Similar Medicare Providers

1144212390 — DR. STEPHEN S. FENSTEMAKER D.D.S.
Practice Location Address:

309 SHERBAN CT
LOUISVILLE, OH
44641-1369

Practice Phone: 330-875-2832
Practice Fax: 330-875-2492

1689791758 — KAROLE A DORAN OTR
Practice Location Address:

6506 WATCH HILL RD
LOUISVILLE, KY
40228-1369

Practice Phone: 502-239-3684
Practice Fax: 502-231-7511

1821379611 — STEPHANIE POUND LPCC-S
Practice Location Address:

3832 TAYLORSVILLE RD STE 2
LOUISVILLE, KY
40220-1369

Practice Phone: 502-554-0202
Practice Fax:

1124684212 — KAYLA RENAE COMBS NP-C
Practice Location Address:

3832 TAYLORSVILLE RD UNIT 8-10
LOUISVILLE, KY
40220-1369

Practice Phone: 502-649-6219
Practice Fax:

1760147482 — D&S RESIDENTIAL SERVICES, LP
Practice Location Address:

3832 TAYLORSVILLE RD
LOUISVILLE, KY
40220-1369

Practice Phone: 606-425-4432
Practice Fax:

1851105878 — POWER INTO PURPOSE LLC
Practice Location Address:

901 S 15TH ST STE 117
LOUISVILLE, KY
40210-1369

Practice Phone: 502-744-2105
Practice Fax:

Directions to “ELDERCLUB ADC ELDERSERVE INC. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.