Provider Demographics
NPI:1124375092
Name:CHRISTIAN CARE AT HOME - PENNYROYAL, LIMITED
Entity Type:Organization
Organization Name:CHRISTIAN CARE AT HOME - PENNYROYAL, LIMITED
Other - Org Name:CHRISTIAN CARE AT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:R
Authorized Official - Last Name:KNAPP
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:502-254-4200
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:502-254-4200
Mailing Address - Fax:502-254-4209
Practice Address - Street 1:122 W UNION ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:KY
Practice Address - Zip Code:42347-1416
Practice Address - Country:US
Practice Address - Phone:270-298-3112
Practice Address - Fax:270-298-4766
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHRISTIAN CARE COMMUNITIES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-10
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY150138251B00000X
KY750182251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251B00000XAgenciesCase Management