Organization
PARK DUVALLE COMMUNITY HEALTH CENTER, INC.
Active
Parent organization
PARK DUVALLE COMMUNITY HEALTH CENTER, INC
Other names
Russell Neighborood Health Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
PARK DUVALLE COMMUNITY HEALTH CENTER, INC
Authorized official
SWANNIE JETT (CEO)
(502) 774-4401
Entity
Organization
Contact information
Practice address
1425 W. BROADWAY, LOUISVILLE, KY 40202
(502) 584-2992
(502) 584-3715
Mailing address
3015 WILSON AVE, LOUISVILLE, KY 40211-1969
(502) 774-4401
(502) 772-4783
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
700005
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31000011
—
KY
Enumeration date
07/26/2006
Last updated
11/02/2021
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