Provider Demographics
NPI:1083094932
Name:CORNELL MEMORY CENTER
Entity Type:Organization
Organization Name:CORNELL MEMORY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, CENTRAL BILLING OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-254-4258
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:40243-2534
Mailing Address - Country:US
Mailing Address - Phone:502-254-4258
Mailing Address - Fax:502-254-4209
Practice Address - Street 1:101 NORTH DRIVE
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240
Practice Address - Country:US
Practice Address - Phone:270-885-1375
Practice Address - Fax:270-885-1377
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHRISTIAN CARE COMMUNITIES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-05
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care