PARK DUVALLE COMMUNITY HEALTH CENTER, INC. (NPI# 1255354361) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255354361 |
| Entity Type | Organization |
| Organization Name | PARK DUVALLE COMMUNITY HEALTH CENTER, INC. |
| Other Organization Name | RUSSELL NEIGHBOROOD HEALTH CENTER |
| Practice Address |
1015 W Chestnut St Louisville KY 40203-2048 |
| Mailing Address |
3015 Wilson Ave Louisville KY 40211-1969 |
| Practice Telephone | 5025842992 |
| Practice Fax Number | 5025843715 |
| Mailing Telephone | 5027744401 |
| Mailing Fax Number | 5027724783 |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2019-04-26 |
| Authorized Official Name | ELIZABETH ANN HAGAN-GRIGSBY (CEO) |
| Authorized Official Telephone | 5027744401 |
| Is Organization Subpart | Y |
| Parent Organization Name | PARK DUVALLE COMMUNITY HEALTH CENTER, INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
700005 | KY | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KY | 31000011 | 05 |
| Other Name | Type Code |
|---|---|
| Park DuValle at City View | Other Name - Individual/Organization |
| Russell Neighborood Health Center | Doing Business As Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1425 W. Broadway, Louisville, KY 40202 | 5025842992 | 5025843715 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942214663 | Park Duvalle Community Health Center, Inc. | Clinic/Center | 311 Reasor Ave, Taylorsville, KY 40071-0567 | 2006-07-28 |
| 1245253160 | Park Duvalle Community Health Center, Inc. | Clinic/Center | 3015 Wilson Ave, Louisville, KY 40211-1969 | 2006-07-25 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | PARK DUVALLE COMMUNITY HEALTH CENTER, INC. | 3015 Wilson Ave, Louisville, KY 40211-1969 |
| Street Address |
1015 W CHESTNUT ST |
| City | LOUISVILLE |
| State | KY |
| Zip Code | 40203-2048 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881940658 | Robert Donald Wood II | Dentist | 1015 W Chestnut St, Louisville, KY 40203-2048 | 2012-07-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295211738 | Integrated Health Systems LLC | Psychiatry & Neurology | 645 S Roy Wilkins Ave Ste 300, Louisville, KY 40203 | 2018-07-18 |
| 1104317734 | Usimc of West Virginia Medical Corporation | Clinic/Center | 908 W Broadway Fl 8, Louisville, KY 40203 | 2018-05-18 |
| 1699296293 | Jennifer Christine Angermeier | Nurse Practitioner | 1130 W Chestnut St, Louisville, KY 40203 | 2017-07-05 |
| 1083162812 | Deloris Jean Johnson | Social Worker | 1022 South 6th Street, Louisville, KY 40203 | 2016-09-21 |
| 1770978512 | Michael Bricken | Pediatrics | 760 S Hancock St # B100, Louisville, KY 40203 | 2015-03-30 |
| 1770906885 | Jason Scott Underhill | Counselor | 214 E Breckinridge St, Louisville, KY 40203 | 2014-01-24 |
| 1316372592 | Tonya Alicia Clay | Marriage & Family Therapist | 1000 South 5th Street, Family & Children's Place, Louisville, KY 40203 | 2013-09-06 |
| 1780929216 | Harambee Health Center, Inc | Clinic/Center | 800 South Preston St., Louisville, KY 40203 | 2012-12-10 |
| 1083977276 | Synergy Rehabilitation, Inc. | Physical Therapist | 832 S. 6th Street, Suite C, Louisville, KY 40203 | 2012-06-21 |
| 1043572803 | Sonya Helen Mitchell | Counselor | 2225 W. Broadway, Louisville, KY 40203 | 2012-06-07 |
| Find all providers in zip 40203 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649732603 | Family Health Centers, Inc. | Clinic/Center | 4803 Southside Dr, Louisville, KY 40214-2111 | 2019-04-01 |
| 1578774477 | Family Health Centers, Inc. | Clinic/Center | 4805 Southside Dr, Louisville, KY 40214-2111 | 2007-05-24 |
| 1770680019 | Greater Meridian Health Clinic, Inc. | Clinic/Center | 14130 Highway 15 S Ste D, Louisville, MS 39339-6452 | 2006-09-20 |
| 1780698506 | Park Duvalle Community Health Center, Inc | Clinic/Center | 2237 Hikes Ln, Louisville, KY 40218-2203 | 2006-07-28 |
| 1275151292 | Park Duvalle Community Health Center, Inc | Clinic/Center | 3015 Wilson Ave, Louisville, KY 40211-1969 | 2020-07-07 |
| 1639727951 | Park Duvalle Community Health Center, Inc | Clinic/Center | 1130 W Chestnut St, Louisville, KY 40203-2047 | 2019-08-29 |
| 1811545403 | Park Duvalle Community Health Center, Inc | Clinic/Center | 5901 Greenwood Rd, Louisville, KY 40258-2409 | 2019-08-28 |
| 1427574862 | Family Health Centers, Inc. | Clinic/Center | 2500 W Market St, Louisville, KY 40212-1541 | 2017-08-17 |
| 1245253160 | Park Duvalle Community Health Center, Inc. | Clinic/Center | 3015 Wilson Ave, Louisville, KY 40211-1969 | 2006-07-25 |
| 1134172489 | Family Health Centers, Inc. | Clinic/Center | 834 E Broadway, Louisville, KY 40204-1072 | 2006-05-18 |
| Find all providers in LOUISVILLE | ||||
| City | LOUISVILLE |
| Zip Code | 40203 |
Please comment or provide details below to improve the information on PARK DUVALLE COMMUNITY HEALTH CENTER, INC..
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.