Provider Demographics
NPI:1790378628
Name:KENTUCKY HOME CARE LLC
Entity Type:Organization
Organization Name:KENTUCKY HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-556-1315
Mailing Address - Street 1:101 HIGH ST STE C
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:KY
Mailing Address - Zip Code:40383-1585
Mailing Address - Country:US
Mailing Address - Phone:859-251-4400
Mailing Address - Fax:859-251-4401
Practice Address - Street 1:101 HIGH ST STE C
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:KY
Practice Address - Zip Code:40383-1585
Practice Address - Country:US
Practice Address - Phone:859-251-4400
Practice Address - Fax:859-251-4401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care