MEDICARE: TRILOGY HEALTHCARE OF JEFFERSON, 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	310400000X	Assisted Living Facility
2	314000000X	Skilled Nursing Facility	100196	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	:	1811132350
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRILOGY HEALTHCARE OF JEFFERSON, LLC

Provider Business Mailing Address
First Line	:	3625 FERN VALLEY RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40219-1916
Country	:	US
Telephone Number	:	502-964-3381
Fax Number	:	502-964-7414

Provider Business Practice Location Address
First Line	:	3625 FERN VALLEY RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40219-1916
Country	:	US
Telephone Number	:	502-964-3381
Fax Number	:	502-964-7414

Authorized Official
Title or Position	:	EVP & CLO
Name	:	CRISTINA PIETROWSKI
Credential	:
Telephone Number	:	502-213-7572

Provider Enumeration Date	:	12/12/2008
Last Update Date	:	09/17/2025

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