Provider Demographics
NPI:1669641635
Name:ST. MARY'S CENTER, INC.
Entity Type:Organization
Organization Name:ST. MARY'S CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEVELACQUA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-254-7298
Mailing Address - Street 1:PO BOX 43443
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40253-0443
Mailing Address - Country:US
Mailing Address - Phone:502-254-7298
Mailing Address - Fax:
Practice Address - Street 1:11700 MAIN ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-1426
Practice Address - Country:US
Practice Address - Phone:502-254-7298
Practice Address - Fax:502-254-7298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services