1386795631 NPI number — EMPICARE, INC.

Table of content: (NPI 1386795631)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386795631 NPI number — EMPICARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMPICARE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386795631
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11802 BRINLEY AVE
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40243-1089
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-244-2774
Provider Business Mailing Address Fax Number:
502-244-8085

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6444 MONROE ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
SYLVANIA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43560-1454
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-885-2793
Provider Business Practice Location Address Fax Number:
419-885-3519
Provider Enumeration Date:
01/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TRASK
Authorized Official First Name:
REBECCA
Authorized Official Middle Name:
D
Authorized Official Title or Position:
VP, CORPORATE DEVELOPMENT
Authorized Official Telephone Number:
502-244-2774

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  48171548 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 335E00000X , with the licence number: 48171548 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2557693 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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