Kentucky Life Source Inc

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

KENTUCKY LIFE SOURCE INC

Practice address

2619 W Broadway
Louisville, KY 40211-1332

Phone

(502) 303-7665

NPI assigned

Mar 4, 2024

Last updated

Mar 13, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jacqueline Sanders

Title

Credentialing Admin

Phone

(502) 365-3394

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1709510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741824000000",
    "number": "1083471262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2619 W BROADWAY",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402111332",
            "telephone_number": "502-303-7665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2619 W BROADWAY",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402111332",
            "telephone_number": "502-303-7665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENTUCKY LIFE SOURCE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-04",
        "last_updated": "2025-03-13",
        "certification_date": "2025-03-13",
        "status": "A",
        "authorized_official_last_name": "SANDERS",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_title_or_position": "CREDENTIALING ADMIN",
        "authorized_official_telephone_number": "502-365-3394"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kentucky Health Partners, LLC
• Kentucky Independent Support Services
• Kentucky Injury & Rehab LLC
• Kentucky Injury Care Centers, LLC
• Kentucky Joint Specialists LLC
• Kentucky Lions Eye Foundation, Inc.
• Kentucky Medical Specialists, PSC
• Kentucky Mental Health Care, L.L.C.
• Kentucky Neuro Associates
• Kentucky OB Hospitalist Services Inc

• Community/Behavioral Health Agency in Louisville, KY
• Providers in Louisville, KY by specialty
• Community/Behavioral Health Agency in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.