Provider Demographics
NPI:1427051218
Name:FULTON HOME CARE SERVICES LLC
Entity type:Organization
Organization Name:FULTON HOME CARE SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:LYLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-891-1044
Mailing Address - Street 1:9510 ORMSBY STATION RD
Mailing Address - Street 2:STE 300
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-4081
Mailing Address - Country:US
Mailing Address - Phone:502-891-1187
Mailing Address - Fax:502-891-8067
Practice Address - Street 1:17 CONSTRUCTION RD
Practice Address - Street 2:STE F
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066-6754
Practice Address - Country:US
Practice Address - Phone:270-247-3155
Practice Address - Fax:270-247-0803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2017-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY150122251E00000X, 251J00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY34003384Medicaid
KY42002386Medicaid
KY187120Medicare Oscar/Certification