Provider Demographics
NPI:1205823812
Name:CARE CENTER OF LOUISVILLE, LTD.
Entity Type:Organization
Organization Name:CARE CENTER OF LOUISVILLE, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:GWIN
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-773-8047
Mailing Address - Street 1:PO BOX 542
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39339-0542
Mailing Address - Country:US
Mailing Address - Phone:662-773-8047
Mailing Address - Fax:662-773-2530
Practice Address - Street 1:543 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:MS
Practice Address - Zip Code:39339-2709
Practice Address - Country:US
Practice Address - Phone:662-773-8047
Practice Address - Fax:662-773-2530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS562314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00230036Medicaid
MS00230036Medicaid