Provider Demographics
NPI:1558698852
Name:SOUTHWEST CENTER FOR THE DEVELOPMENTALLY DISABLED
Entity Type:Organization
Organization Name:SOUTHWEST CENTER FOR THE DEVELOPMENTALLY DISABLED
Other - Org Name:SOUTHWEST CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:SLUCHER
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN,MHA
Authorized Official - Phone:502-935-1848
Mailing Address - Street 1:8009 TERRY RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40258-2669
Mailing Address - Country:US
Mailing Address - Phone:502-935-1848
Mailing Address - Fax:502-933-7833
Practice Address - Street 1:8009 TERRY RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40258-2669
Practice Address - Country:US
Practice Address - Phone:502-935-1848
Practice Address - Fax:502-933-7833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-06
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)