Mahoghany Tree Rooted Resources

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

MAHOGHANY TREE ROOTED RESOURCES

Practice address

4059 La Salle Ave
Louisville, KY 40215-1321

Phone

(502) 579-0170

NPI assigned

Sep 22, 2023

Organization subpart

No

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

Authorized official

Name

Nasira Mah-Jabeen

Title

Credentialing Agent

Phone

(502) 579-0170

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1695340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695340800000",
    "number": "1508645201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "642 CECIL AVE",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402113162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4059 LA SALLE AVE",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402151321",
            "telephone_number": "502-579-0170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAHOGHANY TREE ROOTED RESOURCES",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-22",
        "last_updated": "2023-09-22",
        "certification_date": "2023-09-22",
        "status": "A",
        "authorized_official_last_name": "MAH-JABEEN",
        "authorized_official_first_name": "NASIRA",
        "authorized_official_title_or_position": "CREDENTIALING AGENT",
        "authorized_official_telephone_number": "502-579-0170"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas Richard Maher Jr., MD
• Cynthia Cox Mahin, M.D.
• Sirlivia Bell Demorna Mahin, MRC, CRC, LPCA
• Emaan Mahmood
• Omar Mahmood
• Caitlin Marie Mahon, APRN, FNP-C, RD, LD
• Francis Mahon, PT
• Erica N Mahone, APRN
• Jamila Mahone, TLBA, RBT
• Sharletta Kay Mahone, LMFT

• Multi-Specialty Clinic/Center in Louisville, KY
• Providers in Louisville, KY by specialty
• Multi-Specialty Clinic/Center in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 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.