Provider Demographics
NPI:1851693139
Name:LETS STAY HOME
Entity Type:Organization
Organization Name:LETS STAY HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:BRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-409-1308
Mailing Address - Street 1:136 N CRESTMOOR AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-2735
Mailing Address - Country:US
Mailing Address - Phone:502-409-1308
Mailing Address - Fax:
Practice Address - Street 1:136 N CRESTMOOR AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-2735
Practice Address - Country:US
Practice Address - Phone:502-409-1308
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-19
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service