Basic Information
| Provider Information | |||||||||
| NPI: | 1962425074 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SAINT JOSEPH HOME HEALTH SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1736 ALEXANDRIA DR | ||||||||
| Address2: | SUITE 225 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405043112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592775111 | ||||||||
| FaxNumber: | 8592780597 | ||||||||
| Practice Location | |||||||||
| Address1: | 1736 ALEXANDRIA DR | ||||||||
| Address2: | SUITE 225 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405043112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592775111 | ||||||||
| FaxNumber: | 8592780597 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2006 | ||||||||
| LastUpdateDate: | 06/25/2008 | ||||||||
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| AuthorizedOfficialLastName: | OMIDY | ||||||||
| AuthorizedOfficialFirstName: | GAIL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 8592775111 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SAINT JOSEPH HEALTHCARE | ||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | RN BSN | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 000000000000222693 | 01 | KY | ANTHEM BCBS PROVIDER # | OTHER | 062110315 | 01 | KY | US DEPT OF LABOR PROV # | OTHER | 34022343 | 05 | KY | MEDICAID | 6000173 | 01 | KY | UHC UNIQUE PROVIDER # | OTHER |