Provider Demographics
NPI:1346312824
Name:NAZARETH HOME INC
Entity Type:Organization
Organization Name:NAZARETH HOME INC
Other - Org Name:NAZARETH LITERARY & BENEVOLENT INSTITUTION NAZARETH HOME
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEATLEY
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:502-459-9681
Mailing Address - Street 1:2000 NEWBURG RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-1803
Mailing Address - Country:US
Mailing Address - Phone:502-459-9681
Mailing Address - Fax:502-456-9077
Practice Address - Street 1:2000 NEWBURG RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-1803
Practice Address - Country:US
Practice Address - Phone:502-459-9681
Practice Address - Fax:502-456-9077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100467314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY12500666Medicaid
KY185138Medicare UPIN