Provider Demographics
NPI:1578782470
Name:TRI-GENERATIONS LLC
Entity Type:Organization
Organization Name:TRI-GENERATIONS LLC
Other - Org Name:LOUISVILLE OFFICE
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-253-6825
Mailing Address - Street 1:11800 BRINLEY AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-3007
Mailing Address - Country:US
Mailing Address - Phone:502-253-6825
Mailing Address - Fax:502-253-6828
Practice Address - Street 1:11800 BRINLEY AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-3007
Practice Address - Country:US
Practice Address - Phone:502-253-6825
Practice Address - Fax:502-253-6828
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRI-GENERATIONS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-25
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100148560Medicaid