Provider Demographics
NPI:1447203658
Name:MARIAN HOME-URSULINE SISTERS
Entity Type:Organization
Organization Name:MARIAN HOME-URSULINE SISTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:THIENEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:502-896-3924
Mailing Address - Street 1:3105 LEXINGTON RD
Mailing Address - Street 2:BUILDING 2
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-3061
Mailing Address - Country:US
Mailing Address - Phone:502-896-3909
Mailing Address - Fax:502-515-7517
Practice Address - Street 1:3105 LEXINGTON RD
Practice Address - Street 2:BUILDING 2
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-3061
Practice Address - Country:US
Practice Address - Phone:502-896-3909
Practice Address - Fax:502-515-7517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100482314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY12501763Medicaid
KY12501763Medicaid