Provider Demographics
NPI:1720446479
Name:NAZARETH HOME, INC.
Entity Type:Organization
Organization Name:NAZARETH HOME, INC.
Other - Org Name:DAYBREAK ADULT DAY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:WHEATLEY
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:502-459-9681
Mailing Address - Street 1:2000 NEWBURG RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-1803
Mailing Address - Country:US
Mailing Address - Phone:502-459-9681
Mailing Address - Fax:502-456-9077
Practice Address - Street 1:2120 PAYNE ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-2012
Practice Address - Country:US
Practice Address - Phone:502-895-9425
Practice Address - Fax:502-357-5549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-09
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY750092Medicaid