Provider Demographics
NPI:1982458311
Name:LIL CUTIA ENTERPRISES, LLC
Entity Type:Organization
Organization Name:LIL CUTIA ENTERPRISES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING AGENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-774-0671
Mailing Address - Street 1:1347 S 3RD ST STE 204
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40208-2344
Mailing Address - Country:US
Mailing Address - Phone:502-640-6137
Mailing Address - Fax:502-237-4092
Practice Address - Street 1:1347 S 3RD ST STE 204
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40208-2344
Practice Address - Country:US
Practice Address - Phone:502-640-6137
Practice Address - Fax:502-237-4092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-12
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty