Provider Demographics
NPI:1760563266
Name:EXTENDED CARE HEALTH PROFESSIONALS, PLLC
Entity Type:Organization
Organization Name:EXTENDED CARE HEALTH PROFESSIONALS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:CASHION
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:502-396-7176
Mailing Address - Street 1:3903 VANTAGE PL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-6801
Mailing Address - Country:US
Mailing Address - Phone:502-356-4377
Mailing Address - Fax:888-959-2460
Practice Address - Street 1:3903 VANTAGE PL
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-6801
Practice Address - Country:US
Practice Address - Phone:502-356-4377
Practice Address - Fax:888-959-2460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78904836Medicaid
KY9964Medicare PIN