Basic Information
| Provider Information | |||||||||
| NPI: | 1619634581 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NULEASE MEDICAL SOLUTIONS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5722 OUTER LOOP | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402194156 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5024927455 | ||||||||
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| Practice Location | |||||||||
| Address1: | 333 W DIXIE AVE | ||||||||
| Address2: | |||||||||
| City: | ELIZABETHTOWN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 427011757 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5024927455 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/26/2021 | ||||||||
| LastUpdateDate: | 11/26/2021 | ||||||||
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| AuthorizedOfficialLastName: | CALES | ||||||||
| AuthorizedOfficialFirstName: | SHANNON | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5024927455 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
No ID Information.