Provider Demographics
NPI:1922040815
Name:JEWISH HOSPITAL & ST. MARY'S HEALTHCARE, INC.
Entity Type:Organization
Organization Name:JEWISH HOSPITAL & ST. MARY'S HEALTHCARE, INC.
Other - Org Name:VNA NAZARETH HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCANNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-587-4883
Mailing Address - Street 1:539 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-2535
Mailing Address - Country:US
Mailing Address - Phone:502-584-2456
Mailing Address - Fax:502-584-8059
Practice Address - Street 1:539 S 4TH ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-2535
Practice Address - Country:US
Practice Address - Phone:502-584-2456
Practice Address - Fax:502-584-8059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY150015251E00000X
251J00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY34028563Medicaid
KY41008566Medicare PIN
KY45348463Medicare PIN
KY187000Medicare ID - Type Unspecified