Provider Demographics
NPI:1518954114
Name:MERCY SACRED HEART, INC.
Entity Type:Organization
Organization Name:MERCY SACRED HEART, INC.
Other - Org Name:SACRED HEART VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:502-357-5534
Mailing Address - Street 1:2120 PAYNE ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-2012
Mailing Address - Country:US
Mailing Address - Phone:502-895-9425
Mailing Address - Fax:502-894-9619
Practice Address - Street 1:2120 PAYNE ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-2012
Practice Address - Country:US
Practice Address - Phone:502-895-9425
Practice Address - Fax:502-894-9619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100248313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY12504452Medicaid
KY43012566Medicaid
KY43012566Medicaid