Provider Demographics
NPI:1033215306
Name:CARETENDERS OF NORTHERN KENTUCKY, INC.
Entity Type:Organization
Organization Name:CARETENDERS OF NORTHERN KENTUCKY, INC.
Other - Org Name:CARETENDERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. V.P., ADMINISTRATION
Authorized Official - Prefix:MR
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:SUITE 300
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-4081
Mailing Address - Country:US
Mailing Address - Phone:502-891-1000
Mailing Address - Fax:502-891-8067
Practice Address - Street 1:3037 DIXIE HWY
Practice Address - Street 2:SUITE 215
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-4310
Practice Address - Country:US
Practice Address - Phone:859-578-0022
Practice Address - Fax:859-441-6380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X
KY150165251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY34007591Medicaid
KY42007591Medicaid
KY187303Medicare Oscar/Certification