Provider Demographics
NPI:1891929840
Name:KENTUCKY HOMECARE OF HENDERSON, LLC
Entity Type:Organization
Organization Name:KENTUCKY HOMECARE OF HENDERSON, LLC
Other - Org Name:CARETENDERS HOME HEALTH OF HENDERSON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:GACHASSIN
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:337-233-1307
Mailing Address - Street 1:PO BOX 51266
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70505-1266
Mailing Address - Country:US
Mailing Address - Phone:337-233-1307
Mailing Address - Fax:337-233-5764
Practice Address - Street 1:505 KLUTEY PARK PLAZA DR
Practice Address - Street 2:SUITE A
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-5224
Practice Address - Country:US
Practice Address - Phone:270-869-1997
Practice Address - Fax:270-869-1884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-06
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 261QR0400X, 261QR1300X, 3747P1801X
KY150140251J00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY187136Medicare Oscar/Certification