Provider Demographics
NPI:1881980670
Name:GUARDIAN COMMUNITY LIVING LOUISVILLE, LLC
Entity type:Organization
Organization Name:GUARDIAN COMMUNITY LIVING LOUISVILLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:IRELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-377-9140
Mailing Address - Street 1:105 WESTPARK DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5319
Mailing Address - Country:US
Mailing Address - Phone:615-377-9140
Mailing Address - Fax:615-277-0638
Practice Address - Street 1:5001 CROWN MANOR PL
Practice Address - Street 2:SUITE 200
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-3196
Practice Address - Country:US
Practice Address - Phone:502-540-1482
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services