NPIMap

Organization Active NPI

Commonwealth of Kentucky

Doing business as Hazelwood Center

  • Intellectual Disabilities Intermediate Care Facility
  • Louisville, KY
National Provider Identifier
1033197967
Registry record updated Aug 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
100211 Issued in KY
Legal business name
COMMONWEALTH OF KENTUCKY
Doing business as
Hazelwood Center
Practice address
1800 Bluegrass Ave
Louisville, KY 40215-1130
Phone
(502) 361-2301
Fax
(502) 363-6114
NPI assigned
Dec 30, 2005
Last updated
Aug 7, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
COMMONWEALTH OF KENTUCKYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 7, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jennifer Moore
Title
Assistant Director
Phone
(502) 782-6117

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 100211 KY Primary

Addresses

Primary practice location

1800 Bluegrass Ave
Louisville, KY 40215-1130

Mailing address

1800 Bluegrass Ave
Louisville, KY 40215-1130
Phone (502) 361-2301

Other identifiers 1

IdentifierTypeStateIssuer
11906070MedicaidKY

Other names 1

  • Hazelwood Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1033197967. Details of each certification follow.

  • CCN 18G002 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 18G002

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
Hazelwood Center
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
May 18, 1975
Last certification
Oct 30, 2025
Beds
201
Ownership / control type
State
Most recent change of ownership
Jan 12, 2011
Facility address
1800 Bluegrass Avenue
Louisville, KY 40215

National Provider Directory

National Provider Directory
Tax ID family
Commonwealth of Kentucky126 organizations share this tax ID, including this one
Part of
Commonwealth of Kentucky

Organizations with this tax ID in the same state 15

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 15

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1135900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722988800000",
    "number": "1033197967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 BLUEGRASS AVE",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402151130",
            "telephone_number": "502-361-2301",
            "fax_number": "502-363-6114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 BLUEGRASS AVE",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402151130",
            "telephone_number": "502-361-2301",
            "fax_number": "502-363-6114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMONWEALTH OF KENTUCKY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMMONWEALTH OF KENTUCKY",
        "enumeration_date": "2005-12-30",
        "last_updated": "2024-08-07",
        "certification_date": "2024-08-07",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "ASSISTANT DIRECTOR",
        "authorized_official_telephone_number": "502-782-6117"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "KY",
            "license": "100211",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11906070",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hazelwood Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.