1114024320 NPI number — CARETENDERS OF INDIANA, INC.

Table of content: (NPI 1114024320)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114024320 NPI number — CARETENDERS OF INDIANA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARETENDERS OF INDIANA, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CARETENDERS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114024320
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9510 ORMSBY STATION RD
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40223-4081
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-891-1000
Provider Business Mailing Address Fax Number:
502-891-8067

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5000 BACK SQUARE DR
Provider Second Line Business Practice Location Address:
BUILDING D
Provider Business Practice Location Address City Name:
OWENSBORO
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42301-7411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-685-3876
Provider Business Practice Location Address Fax Number:
270-691-9405
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LYLES
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
TODD
Authorized Official Title or Position:
SR. V.P., ADMINISTRATION
Authorized Official Telephone Number:
502-891-1044

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 252Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000367931 . This is a "ANTHEM PROVIDER NUMBER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 42340026 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 45342599 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 34340109 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 41340019 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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