Provider Demographics
| NPI: | 1780639690 |
|---|---|
| Name: | HOME OF THE INNOCENTS |
| Entity Type: | Organization |
| Organization Name: | HOME OF THE INNOCENTS |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CHIEF FINANCE OFFICIER |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | DAVID |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | MCDONALD |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 502-596-1039 |
| Mailing Address - Street 1: | 1100 E MARKET ST. |
| Mailing Address - Street 2: | |
| Mailing Address - City: | LOUISVILLE |
| Mailing Address - State: | KY |
| Mailing Address - Zip Code: | 40206 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 502-596-1000 |
| Mailing Address - Fax: | 502-596-1413 |
| Practice Address - Street 1: | 1100 E MARKET ST. |
| Practice Address - Street 2: | |
| Practice Address - City: | LOUISVILLE |
| Practice Address - State: | KY |
| Practice Address - Zip Code: | 40206 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 502-596-1000 |
| Practice Address - Fax: | 502-596-1413 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-05-23 |
| Last Update Date: | 2023-10-02 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| 101YP2500X, 103TC0700X, 106H00000X, 235Z00000X, 237600000X, 251S00000X, 363LP0200X | ||
| KY | 740143 | 208000000X, 251B00000X, 208000000X, 208000000X |
| KY | 101130 | 225100000X, 225X00000X, 261QR0400X |
| KY | 100493 | 3140N1450X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
| No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
| No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
| No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Multi-Specialty | |
| No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
| No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
| No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty | |
| No | 237600000X | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter | Group - Multi-Specialty | |
| No | 251B00000X | Agencies | Case Management | Group - Multi-Specialty | |
| No | 251S00000X | Agencies | Community/Behavioral Health | Group - Multi-Specialty | |
| No | 261QR0400X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation | Group - Multi-Specialty |
| No | 3140N1450X | Nursing & Custodial Care Facilities | Skilled Nursing Facility | Nursing Care, Pediatric | Group - Multi-Specialty |
| No | 363LP0200X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| KY | 7100305090 | Medicaid | |
| KY | 7100268020 | Medicaid | |
| KY | 12500989 | Medicaid | |
| KY | 7100281540 | Medicaid | |
| KY | 7100392050 | Medicaid | |
| IN | 201015150A | Medicaid | |
| KY | 65902470 | Medicaid | |
| KY | 7100156180 | Medicaid | |
| KY | 7100173100 | Medicaid | |
| KY | 7100229960 | Medicaid | |
| KY | 7100275730 | Medicaid | |
| KY | 7100315940 | Medicaid | |
| IN | 300031860 | Medicaid |
