Provider Demographics
NPI:1972603843
Name:HOME FOR THE AGED OF THE LITTLE SISTERS OF THE POOR, INC
Entity type:Organization
Organization Name:HOME FOR THE AGED OF THE LITTLE SISTERS OF THE POOR, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:COURTNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-636-2300
Mailing Address - Street 1:15 AUDUBON PLAZA DRIVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40217-1318
Mailing Address - Country:US
Mailing Address - Phone:502-636-2300
Mailing Address - Fax:502-634-0737
Practice Address - Street 1:15 AUDUBON PLAZA DRIVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1318
Practice Address - Country:US
Practice Address - Phone:502-636-2300
Practice Address - Fax:502-634-0737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100641313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY12501185Medicaid
KY185260Medicare ID - Type Unspecified
KY12501185Medicaid