1356528699 NPI number — CHILDREN'S HEALTH FIRST

Table of content: (NPI 1356528699)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356528699 NPI number — CHILDREN'S HEALTH FIRST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHILDREN'S HEALTH FIRST
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:
Provider Other Organization Name Type Code:
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:
1356528699
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2826 HOOCK AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40205-2914
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-459-2397
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1444 WOODBRIDGE TRL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OWENSBORO
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42303-7546
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-929-7888
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/29/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ROGERS
Authorized Official First Name:
JODY
Authorized Official Middle Name:
V
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
502-459-2397

Provider Taxonomy Codes

  • Taxonomy code: 3140N1450X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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