Organization
SOUTHSIDE PERSONAL CARE HOME LLC
Active
Organization
SOUTHSIDE PERSONAL CARE HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ABDIRASHID AHMED KANYARE ADMIN (MANAGER)
(502) 533-1492
Entity
Organization
Contact information
Practice address
5330 S 3RD ST STE 200, LOUISVILLE, KY 40214-2689
(502) 533-1492
(502) 212-9292
Mailing address
5330 S 3RD ST STE 200, LOUISVILLE, KY 40214-2689
(502) 533-1492
(502) 212-9292
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
—
Other
Enumeration date
05/18/2020
Last updated
08/07/2020
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