Provider Demographics
NPI:1710305669
Name:LP LOUISVILLE HOSPITAL SOUTH, LLC
Entity Type:Organization
Organization Name:LP LOUISVILLE HOSPITAL SOUTH, LLC
Other - Org Name:SIGNATURE HEALTHCARE AT U OF L MARY & ELIZABETH HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-568-7800
Mailing Address - Street 1:1850 BLUEGRASS AVE
Mailing Address - Street 2:UNIT 3C
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40215-1161
Mailing Address - Country:US
Mailing Address - Phone:502-361-6000
Mailing Address - Fax:502-361-6799
Practice Address - Street 1:1850 BLUEGRASS AVE
Practice Address - Street 2:UNIT 3C
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-1161
Practice Address - Country:US
Practice Address - Phone:502-361-6000
Practice Address - Fax:502-361-6799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-28
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000Medicare Oscar/Certification