Provider Demographics
NPI:1740488808
Name:FERN CREEK HIGHVIEW UNITED MINISTRIES
Entity type:Organization
Organization Name:FERN CREEK HIGHVIEW UNITED MINISTRIES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:LOUGHRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-239-7431
Mailing Address - Street 1:7502 TANGELO DRIVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40228-3002
Mailing Address - Country:US
Mailing Address - Phone:502-239-7431
Mailing Address - Fax:502-239-7454
Practice Address - Street 1:7502 TANGELO DRIVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40228-3002
Practice Address - Country:US
Practice Address - Phone:502-239-7431
Practice Address - Fax:502-239-7454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY750061261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY43008564Medicaid