Provider Demographics
NPI:1609091669
Name:CARDIOPULMONARY HOME CARE INC
Entity Type:Organization
Organization Name:CARDIOPULMONARY HOME CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:H
Authorized Official - Last Name:SHONTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-937-0877
Mailing Address - Street 1:1300 ENVOY CIR
Mailing Address - Street 2:SUITE 1303
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-2893
Mailing Address - Country:US
Mailing Address - Phone:502-937-0877
Mailing Address - Fax:502-937-0837
Practice Address - Street 1:1300 ENVOY CIR
Practice Address - Street 2:SUITE 1303
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-2893
Practice Address - Country:US
Practice Address - Phone:502-937-0877
Practice Address - Fax:502-937-0837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100004240Medicaid
KY5869910001Medicare NSC