1194786632 NPI number — BAPTIST CONVALESCENT CENTER, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194786632 NPI number — BAPTIST CONVALESCENT CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAPTIST CONVALESCENT CENTER, 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:
BAPTIST HOME HEALTH
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:
1194786632
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 HIGHLAND AVE
Provider Second Line Business Mailing Address:
SUITE 30
Provider Business Mailing Address City Name:
FT WRIGHT
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41011-4001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-547-3353
Provider Business Mailing Address Fax Number:
859-547-3344

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 HIGHLAND AVE
Provider Second Line Business Practice Location Address:
SUITE 30
Provider Business Practice Location Address City Name:
FT WRIGHT
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41011-4001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-547-3353
Provider Business Practice Location Address Fax Number:
859-547-3344
Provider Enumeration Date:
03/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LONG
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
859-491-3800

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  150180 , 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: 34000075 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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