Organization
PARK DUVALLE COMMUNITY HEALTH CENTER, INC
Active
Parent organization
PARK DUVALLE COMMUNITY HEALTH CENTER, INC
Other names
Park Duvalle at Central 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
1130 W CHESTNUT ST, LOUISVILLE, KY 40203-2047
(502) 772-4401
Mailing address
3015 WILSON AVE, LOUISVILLE, KY 40211-1969
(502) 774-4401
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31000011
—
KY
Enumeration date
08/29/2019
Last updated
11/02/2021
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