1578675963 NPI number — BARBOURVILLE NURSING HOME, INC.

Table of content: (NPI 1578675963)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578675963 NPI number — BARBOURVILLE NURSING HOME, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BARBOURVILLE NURSING HOME, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BARBOURVILLE NURSING HOME
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578675963
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1090
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BARBOURVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40906-5090
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-546-5136
Provider Business Mailing Address Fax Number:
606-546-5138

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
117 SHELBY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARBOURVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40906-1623
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-546-5136
Provider Business Practice Location Address Fax Number:
606-546-5138
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FORCHT
Authorized Official First Name:
TERRY
Authorized Official Middle Name:
EMANUEL
Authorized Official Title or Position:
CHAIRMAN
Authorized Official Telephone Number:
606-528-9600

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  100275 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000054764 . This is a "ANTHEM BCBS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 036104200 . This is a "FEDERAL BLACK LUNG" identifier . This identifiers is of the category "OTHER".
  • Identifier: 12501235 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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