1811012289 NPI number — THE EPISCOPAL CHURCH HOME, INC.

Table of content: (NPI 1811012289)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811012289 NPI number — THE EPISCOPAL CHURCH HOME, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE EPISCOPAL CHURCH HOME, 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:
EPISCOPAL CHURCH HOME
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:
1811012289
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3870 VIRGINIA AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45227
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-271-9610
Provider Business Mailing Address Fax Number:
502-425-5277

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7504 WESTPORT ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-736-7800
Provider Business Practice Location Address Fax Number:
502-425-5277
Provider Enumeration Date:
03/21/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LAMB
Authorized Official First Name:
LAURA
Authorized Official Middle Name:
R.P.
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
513-979-2222

Provider Taxonomy Codes

  • Taxonomy code: 311Z00000X , with the licence number:  100203 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 313M00000X , with the licence number: 100203 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X , with the licence number: 100203 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 12502225 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".