Provider Demographics
NPI:1881095586
Name:MYLIANCE
Entity type:Organization
Organization Name:MYLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BYRNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-640-1669
Mailing Address - Street 1:1868 CAMPUS PL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-2305
Mailing Address - Country:US
Mailing Address - Phone:502-640-1669
Mailing Address - Fax:
Practice Address - Street 1:1868 CAMPUS PL
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-2305
Practice Address - Country:US
Practice Address - Phone:502-640-1669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-12
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251B00000XAgenciesCase Management
No251G00000XAgenciesHospice Care, Community Based
No251F00000XAgenciesHome Infusion
No251S00000XAgenciesCommunity/Behavioral Health
No251J00000XAgenciesNursing Care
No251V00000XAgenciesVoluntary or Charitable