Provider Demographics
NPI:1316726094
Name:OUR HOUSE OF FAVOR
Entity type:Organization
Organization Name:OUR HOUSE OF FAVOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAYBAH
Authorized Official - Middle Name:
Authorized Official - Last Name:GLAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-689-2830
Mailing Address - Street 1:135 SHADOW ROCK CT
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40165-4607
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1546 BERRY BLVD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-1955
Practice Address - Country:US
Practice Address - Phone:502-912-2689
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-22
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health