1366431975 NPI number — WHITLEY COUNTY, LLC

Table of content: (NPI 1366431975)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366431975 NPI number — WHITLEY COUNTY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WHITLEY COUNTY, LLC
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:
THE HERITAGE NURSING & REHABILITATION FACILITY
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:
1366431975
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 PROVIDER CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40475-8488
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-623-0898
Provider Business Mailing Address Fax Number:
859-623-0843

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
192 BACON CREEK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORBIN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40701-8639
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-526-1900
Provider Business Practice Location Address Fax Number:
606-526-9892
Provider Enumeration Date:
10/17/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MORROW
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
Authorized Official Title or Position:
VP OF ADMINISTRATIVE SUPPORT
Authorized Official Telephone Number:
859-623-0898

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  100771 , 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: 12503330 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 90160763 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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