Provider Demographics
NPI:1720617004
Name:NEUROCONNEXIONS
Entity Type:Organization
Organization Name:NEUROCONNEXIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ C.E.O
Authorized Official - Prefix:
Authorized Official - First Name:UNEKA
Authorized Official - Middle Name:SHERVON
Authorized Official - Last Name:KENDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-536-6111
Mailing Address - Street 1:4229 BARDSTOWN RD STE 214
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-3241
Mailing Address - Country:US
Mailing Address - Phone:502-536-6111
Mailing Address - Fax:
Practice Address - Street 1:4229 BARDSTOWN RD STE 214
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-3241
Practice Address - Country:US
Practice Address - Phone:502-536-6111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-07
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100379100Medicaid