Provider Demographics
NPI:1558186411
Name:GERALD'S WAY INC
Entity type:Organization
Organization Name:GERALD'S WAY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:STAHR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-631-7621
Mailing Address - Street 1:4805 COFER AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40258-1337
Mailing Address - Country:US
Mailing Address - Phone:502-631-7621
Mailing Address - Fax:
Practice Address - Street 1:4805 COFER AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40258-1337
Practice Address - Country:US
Practice Address - Phone:502-631-7621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-16
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health