Basic Information
| Provider Information | |||||||||
| NPI: | 1861568016 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RESCARE, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 805 N WHITTINGTON PKWY | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402227101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008660860 | ||||||||
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| Practice Location | |||||||||
| Address1: | 15460 TRACEY LN | ||||||||
| Address2: | |||||||||
| City: | INDEPENDENCE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704432470 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9856744177 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2006 | ||||||||
| LastUpdateDate: | 09/28/2022 | ||||||||
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| AuthorizedOfficialLastName: | MATTINGLY | ||||||||
| AuthorizedOfficialFirstName: | ANGIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER PROVIDER ENROLLMENT | ||||||||
| AuthorizedOfficialTelephone: | 5026307425 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| NPICertificationDate: | 09/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 315P00000X | Y | Nursing & Custodial Care Facilities | Intermediate Care Facility, Mentally Retarded |
ID Information
| ID | Type | State | Issuer | Description | 1717142 | 05 | LA | MEDICAID |