Organization
STAR HEALTH CLUB LIMITED LIABILITY COMPANY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DONNA ROGERS RN (ADMINISTRATOR)
(502) 214-3210
Entity
Organization
Contact information
Practice address
4400 BRECKENRIDGE LN STE 102, LOUISVILLE, KY 40218-4082
(502) 214-3210
Mailing address
4400 BRECKENRIDGE LN STE 102, LOUISVILLE, KY 40218-4082
(502) 214-3210
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
Other
Enumeration date
05/02/2022
Last updated
05/02/2022
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