Provider Demographics
NPI:1003295130
Name:THE HOMEPLACE AT MIDWAY, INC.
Entity Type:Organization
Organization Name:THE HOMEPLACE AT MIDWAY, INC.
Other - Org Name:THE HOME PLACE - MIDWAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DADDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-254-4208
Mailing Address - Street 1:12710 TOWNEPARK WAY
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-1596
Mailing Address - Country:US
Mailing Address - Phone:502-254-4200
Mailing Address - Fax:502-254-4209
Practice Address - Street 1:671 E STEPHENS ST
Practice Address - Street 2:
Practice Address - City:MIDWAY
Practice Address - State:KY
Practice Address - Zip Code:40347-1134
Practice Address - Country:US
Practice Address - Phone:502-254-4258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHRISTIAN CARE COMMUNITIES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-05-21
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility