Provider Demographics
NPI:1932504172
Name:LOUISVILLE JEFFERSON COUNTY METRO GOVERNMENT
Entity Type:Organization
Organization Name:LOUISVILLE JEFFERSON COUNTY METRO GOVERNMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FISCAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EVETTE
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-574-6580
Mailing Address - Street 1:611 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-2743
Mailing Address - Country:US
Mailing Address - Phone:502-574-6580
Mailing Address - Fax:
Practice Address - Street 1:4500 CHURCHMAN AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-1188
Practice Address - Country:US
Practice Address - Phone:502-574-6414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-30
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadoneGroup - Single Specialty
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100589030Medicaid