Provider Demographics
NPI:1578305918
Name:HOUSE OF EMILY ALICE & LOUISE
Entity type:Organization
Organization Name:HOUSE OF EMILY ALICE & LOUISE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NASIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAH-JABEEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-384-5149
Mailing Address - Street 1:1800 W MUHAMMAD ALI BLVD STE 2C
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40203-1560
Mailing Address - Country:US
Mailing Address - Phone:502-384-5149
Mailing Address - Fax:502-384-3447
Practice Address - Street 1:1944 W JEFFERSON ST STE 1
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40203-1526
Practice Address - Country:US
Practice Address - Phone:502-384-5149
Practice Address - Fax:502-384-3447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty