Provider Demographics
NPI:1356398929
Name:DIABETES RESOURCE CENTER, INC
Entity type:Organization
Organization Name:DIABETES RESOURCE CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:EMILIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRABOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-895-2334
Mailing Address - Street 1:PO BOX 6337
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-0337
Mailing Address - Country:US
Mailing Address - Phone:502-895-2334
Mailing Address - Fax:502-896-6987
Practice Address - Street 1:920 DUPONT RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4692
Practice Address - Country:US
Practice Address - Phone:502-895-2334
Practice Address - Fax:502-896-6987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90800566Medicaid
KY90800566Medicaid