MEDICARE: SHIVELY FIRST HEALTH CARE, 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1811775679
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHIVELY FIRST HEALTH CARE, LLC

Provider Business Mailing Address
First Line	:	924 E BROADWAY
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40204-1057
Country	:	US
Telephone Number	:	502-200-1335
Fax Number	:	502-200-8904

Provider Business Practice Location Address
First Line	:	924 E BROADWAY
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40204-1057
Country	:	US
Telephone Number	:	502-200-1335
Fax Number	:	502-200-8904

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	MR. DEVIN PANTESS
Credential	:
Telephone Number	:	502-259-8811

Provider Enumeration Date	:	09/21/2023
Last Update Date	:	01/17/2026

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