Provider Demographics
NPI:1699224154
Name:HOME PLUS OF KENTUCKY / WISEARK LLC
Entity Type:Organization
Organization Name:HOME PLUS OF KENTUCKY / WISEARK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:HEATH
Authorized Official - Middle Name:
Authorized Official - Last Name:CULBERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-954-1133
Mailing Address - Street 1:PO BOX 142
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:KY
Mailing Address - Zip Code:41040-0142
Mailing Address - Country:US
Mailing Address - Phone:859-954-1133
Mailing Address - Fax:
Practice Address - Street 1:214 W SHELBY ST
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:KY
Practice Address - Zip Code:41040-1140
Practice Address - Country:US
Practice Address - Phone:859-954-1133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-26
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty