Organization
PARK DUVALLE COMMUNITY HEALTH CENTER, INC
Active
Other names
Park DuValle at Newburg
Organization subpart
No
Provider details
NPI number
Authorized official
SWANNIE JETT (CEO)
(502) 774-4401
Entity
Organization
Contact information
Practice address
3828 BARDSTOWN RD, LOUISVILLE, KY 40218-1527
(502) 479-8930
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
07/28/2006
Last updated
11/11/2022
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