Organization
THE PRINCECARE GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JIM DEWAYNE HISLE (PRESIDENT)
(502) 428-9037
Entity
Organization
Contact information
Practice address
1520 BAXTER AVE, LOUISVILLE, KY 40205
(502) 896-8147
(502) 896-8149
Mailing address
1520 BAXTER AVE, LOUISVILLE, KY 40205-1009
(502) 896-8147
(502) 896-8149
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
261Q00000X
Clinic/Center
—
—
261QA0600X
Adult Day Care Clinic/Center
7100233390
KY
261QD1600X
Developmental Disabilities Clinic/Center
—
—
261QP2000X
Physical Therapy Clinic/Center
7100199960
KY
261QR0400X
Rehabilitation Clinic/Center
—
KY
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
7100010990
KY
Other
Enumeration date
04/20/2007
Last updated
07/12/2018
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