1962425074 NPI number — SAINT JOSEPH HOME HEALTH SERVICES

Table of content: (NPI 1962425074)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962425074 NPI number — SAINT JOSEPH HOME HEALTH SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAINT JOSEPH HOME HEALTH SERVICES
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:
1962425074
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1736 ALEXANDRIA DR
Provider Second Line Business Mailing Address:
SUITE 225
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40504-3112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-277-5111
Provider Business Mailing Address Fax Number:
859-278-0597

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1736 ALEXANDRIA DR
Provider Second Line Business Practice Location Address:
SUITE 225
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40504-3112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-277-5111
Provider Business Practice Location Address Fax Number:
859-278-0597
Provider Enumeration Date:
07/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
OMIDY
Authorized Official First Name:
GAIL
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR ADMINISTRATOR
Authorized Official Telephone Number:
859-277-5111

Provider Taxonomy Codes

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

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

  • Identifier: 000000000000222693 . This is a "ANTHEM BCBS PROVIDER #" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 062110315 . This is a "US DEPT OF LABOR PROV #" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 34022343 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6000173 . This is a "UHC UNIQUE PROVIDER #" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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