PARK DUVALLE COMMUNITY HEALTH CENTER, INC. (NPI# 1245253160) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245253160 |
| Entity Type | Organization |
| Organization Name | PARK DUVALLE COMMUNITY HEALTH CENTER, INC. |
| Practice Address |
3015 Wilson Ave Louisville KY 40211-1969 |
| Practice Telephone | 5027744401 |
| Practice Fax Number | 5027724783 |
| Mailing Telephone | 5027744401 |
| Mailing Fax Number | 5027724783 |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2016-12-19 |
| Authorized Official Name | ELIZABETH ANN HAGAN-GRIGSBY (CEO) |
| Authorized Official Telephone | 5027744401 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
700005 | KY | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KY | 31000011 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942214663 | Park Duvalle Community Health Center, Inc. | Clinic/Center | 311 Reasor Ave, Taylorsville, KY 40071-0567 | 2006-07-28 |
| 1255354361 | Park Duvalle Community Health Center, Inc. | Clinic/Center | 1015 W Chestnut St, Louisville, KY 40203-2048 | 2006-07-26 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | PARK DUVALLE COMMUNITY HEALTH CENTER, INC. | 3015 Wilson Ave, Louisville, KY 40211-1969 |
| Street Address |
3015 WILSON AVE |
| City | LOUISVILLE |
| State | KY |
| Zip Code | 40211-1969 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275534091 | Lisa G Glass | Nurse Practitioner | 3015 Wilson Ave, Louisville, KY 40211-1969 | 2005-08-02 |
| 1083215362 | Yazmine Jaquez | Nurse Practitioner | 3015 Wilson Ave, Louisville, KY 40211-1969 | 2020-11-04 |
| 1982211405 | Domini Williams | Nurse Practitioner | 3015 Wilson Ave, Louisville, KY 40211-1969 | 2020-09-29 |
| 1497361091 | Treana Redd | Nurse Practitioner | 3015 Wilson Ave, Louisville, KY 40211-1969 | 2020-09-18 |
| 1356954366 | Janneve Sankawulo | Nurse Practitioner | 3015 Wilson Ave, Louisville, KY 40211-1969 | 2020-08-28 |
| 1588274260 | Robyn May | Dentist | 3015 Wilson Ave, Louisville, KY 40211-1969 | 2020-08-06 |
| 1124638184 | Symone Stephens | Registered Nurse | 3015 Wilson Ave, Louisville, KY 40211-1969 | 2020-08-05 |
| 1275151292 | Park Duvalle Community Health Center, Inc | Clinic/Center | 3015 Wilson Ave, Louisville, KY 40211-1969 | 2020-07-07 |
| 1598312415 | Elissa Grider | Nurse Practitioner | 3015 Wilson Ave, Louisville, KY 40211-1969 | 2019-08-26 |
| 1730733783 | Mark A Bush | Nurse Practitioner | 3015 Wilson Ave, Louisville, KY 40211 | 2019-07-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942792940 | Kare LLC | Dentist | 2500 W Broadway Ste 500, Louisville, KY 40211 | 2018-06-05 |
| 1265943716 | Practicare Home Care Services, LLC | Nurse Practitioner | 1667 Russell Lee Dr, Louisville, KY 40211 | 2017-10-23 |
| 1518478221 | Latoya Samantha Hall | Counselor | 646 South 36th Street, Louisville, KY 40211 | 2017-10-20 |
| 1003071200 | Mark Cassol Md Psc | Ophthalmology | 2600 W. Broadway, Suite 105, Louisville, KY 40211 | 2008-07-28 |
| 1194919548 | Hardin Housing Corp | Assisted Living Facility | 2035 S 41st St, Louisville, KY 40211 | 2007-08-29 |
| 1184770562 | Eta Day Care Center LLC | Case Management | 724 So 44th Street, Louisville, KY 40211 | 2007-01-26 |
| 1871571356 | Alice C Gunnison | Physician Assistant | 2406 West Broadway, Jencare Neighborhood Medical Center West Broadway, LLC, Louisville, KY 40211 | 2006-01-05 |
| 1730694266 | Orchid House, Inc. | Early Intervention Provider Agency | 703 S 31st St, Louisville, KY 40211 | 2017-12-06 |
| 1891188785 | Mary Jo Pitts | Registered Nurse | 2406 West Broadway, Jencare Neighborhood Medical Center West Broadway, LLC, Louisville, KY 40211 | 2015-03-17 |
| 1164717492 | Priscilla Nana Ama Owusu | Internal Medicine | 2406 W Broadway, Louisville, KY 40211 | 2011-06-15 |
| Find all providers in zip 40211 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649732603 | Family Health Centers, Inc. | Clinic/Center | 4803 Southside Dr, Louisville, KY 40214-2111 | 2019-04-01 |
| 1578774477 | Family Health Centers, Inc. | Clinic/Center | 4805 Southside Dr, Louisville, KY 40214-2111 | 2007-05-24 |
| 1770680019 | Greater Meridian Health Clinic, Inc. | Clinic/Center | 14130 Highway 15 S Ste D, Louisville, MS 39339-6452 | 2006-09-20 |
| 1780698506 | Park Duvalle Community Health Center, Inc | Clinic/Center | 2237 Hikes Ln, Louisville, KY 40218-2203 | 2006-07-28 |
| 1255354361 | Park Duvalle Community Health Center, Inc. | Clinic/Center | 1015 W Chestnut St, Louisville, KY 40203-2048 | 2006-07-26 |
| 1275151292 | Park Duvalle Community Health Center, Inc | Clinic/Center | 3015 Wilson Ave, Louisville, KY 40211-1969 | 2020-07-07 |
| 1639727951 | Park Duvalle Community Health Center, Inc | Clinic/Center | 1130 W Chestnut St, Louisville, KY 40203-2047 | 2019-08-29 |
| 1811545403 | Park Duvalle Community Health Center, Inc | Clinic/Center | 5901 Greenwood Rd, Louisville, KY 40258-2409 | 2019-08-28 |
| 1427574862 | Family Health Centers, Inc. | Clinic/Center | 2500 W Market St, Louisville, KY 40212-1541 | 2017-08-17 |
| 1134172489 | Family Health Centers, Inc. | Clinic/Center | 834 E Broadway, Louisville, KY 40204-1072 | 2006-05-18 |
| Find all providers in LOUISVILLE | ||||
| City | LOUISVILLE |
| Zip Code | 40211 |
Please comment or provide details below to improve the information on PARK DUVALLE COMMUNITY HEALTH CENTER, INC..
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.