| Home Of The Innocents, Inc. | |
|
1050 E Market St Louisville KY 40206-1874 | |
| (502) 596-1090 | |
| (502) 596-1410 |
| Full Name | Home Of The Innocents, Inc. |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1050 E Market St, Louisville, Kentucky |
| Authorized Official Name and Position | Candice Dick (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 5025961245 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Home Of The Innocents, Inc. 1050 E Market St Louisville KY 40206-1874 Ph: (502) 596-1090 | Home Of The Innocents, Inc. 1050 E Market St Louisville KY 40206-1874 Ph: (502) 596-1090 |
| NPI Number | 1477861888 |
|---|---|
| Provider Enumeration Date | 09/20/2010 |
| Last Update Date | 01/04/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477861888 | NPI | - | NPPES |
| 29101185 | Medicaid | KY | |
| 7100126000 | Medicaid | KY | |
| 12500989 | Medicaid | KY | |
| 29201183 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 740143 (Kentucky) | Primary |
| 261QM2500X | Clinic/center - Medical Specialty | 740143 (Kentucky) | Secondary |
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