Provider Demographics
NPI:1831243799
Name:CHERRICARE, MEDICAL EQUIPMENT AND SUPPLIES
Entity type:Organization
Organization Name:CHERRICARE, MEDICAL EQUIPMENT AND SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:STONE
Authorized Official - Last Name:LOLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:270-926-2252
Mailing Address - Street 1:401 BOLIVAR ST
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-4246
Mailing Address - Country:US
Mailing Address - Phone:270-926-2522
Mailing Address - Fax:270-926-7647
Practice Address - Street 1:401 BOLIVAR ST
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-4246
Practice Address - Country:US
Practice Address - Phone:270-926-2522
Practice Address - Fax:270-926-7647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY332BC3200X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90480302Medicaid
KY45909520Medicaid
KY1182430001Medicare NSC