Provider Demographics
NPI:1114024320
Name:CARETENDERS OF INDIANA, INC.
Entity Type:Organization
Organization Name:CARETENDERS OF INDIANA, 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 1:5000 BACK SQUARE DR
Practice Address - Street 2:BUILDING D
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-7411
Practice Address - Country:US
Practice Address - Phone:270-685-3876
Practice Address - Fax:270-691-9405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251B00000XAgenciesCase Management
No251J00000XAgenciesNursing Care
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000367931OtherANTHEM PROVIDER NUMBER
KY42340026Medicaid
KY45342599Medicaid
KY34340109Medicaid
KY41340019Medicaid
KY187178Medicare Oscar/Certification