Organization Active NPI

Personal Care Agency

  • Assisted Living Facility (Mental Illness)
  • Louisville, KY
National Provider Identifier
1104510502
Registry record updated Jun 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X
Legal business name
PERSONAL CARE AGENCY
Practice address
2305 Grand Ave
Louisville, KY 40210-1145
Phone
(502) 777-9201
NPI assigned
Jun 7, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2023

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

Authorized official

Name
Ms. Shavonda HillNPI 1316631724
Title
Owner
Phone
(502) 416-2988

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility (Mental Illness) 3104A0625X Primary
Non-emergency Medical Transport (VAN) 343900000X

Addresses

Primary practice location

2305 Grand Ave
Louisville, KY 40210-1145

Mailing address

2305 Grand Ave
Louisville, KY 40210-1145
Phone (502) 416-2988

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1686096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686096000000",
    "number": "1104510502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2305 GRAND AVE",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402101145",
            "telephone_number": "502-416-2988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2305 GRAND AVE",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402101145",
            "telephone_number": "502-777-9201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERSONAL CARE AGENCY",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-07",
        "last_updated": "2023-06-07",
        "certification_date": "2023-06-07",
        "status": "A",
        "authorized_official_last_name": "HILL",
        "authorized_official_first_name": "SHAVONDA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "502-416-2988",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2023; 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.