Provider Demographics
NPI:1003846205
Name:TRILOGY HEALTHCARE OF LOUISVILLE SOUTHWEST, LLC
Entity Type:Organization
Organization Name:TRILOGY HEALTHCARE OF LOUISVILLE SOUTHWEST, LLC
Other - Org Name:PARK TERRACE HEALTH CAMPUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT- FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:P
Authorized Official - Last Name:PLEVYAK
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:502-213-1710
Mailing Address - Street 1:9700 STONESTREET RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40272-2884
Mailing Address - Country:US
Mailing Address - Phone:502-995-6600
Mailing Address - Fax:
Practice Address - Street 1:9700 STONESTREET RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40272-2884
Practice Address - Country:US
Practice Address - Phone:502-995-6600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY12505228Medicaid
KY185462Medicare ID - Type Unspecified