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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