Provider Demographics
NPI:1295254332
Name:ON-SITE ENTERPRISES OF OLDHAM,LLC
Entity type:Organization
Organization Name:ON-SITE ENTERPRISES OF OLDHAM,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:WADDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-819-1600
Mailing Address - Street 1:PO BOX 1395
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40014-1395
Mailing Address - Country:US
Mailing Address - Phone:502-819-1600
Mailing Address - Fax:
Practice Address - Street 1:7109 APPLE ORCHARD LN
Practice Address - Street 2:
Practice Address - City:CRESTWOOD
Practice Address - State:KY
Practice Address - Zip Code:40014-9068
Practice Address - Country:US
Practice Address - Phone:502-819-1600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-10
Last Update Date:2017-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYM95083756347C00000X
3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No347C00000XTransportation ServicesPrivate Vehicle