1508831033 NPI number — RBRC, INC.

Table of content: (NPI 1508831033)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508831033 NPI number — RBRC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RBRC, 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:
RIVERS BEND RETIREMENT COMMUNITY
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:
1508831033
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 127
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UNIONTOWN
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42461-0127
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-822-4218
Provider Business Mailing Address Fax Number:
270-822-4210

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 BEECH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KUTTAWA
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42055-6214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-388-2868
Provider Business Practice Location Address Fax Number:
270-388-2945
Provider Enumeration Date:
02/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BEAVEN
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
T.
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
270-822-4218

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  20010207201 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 311Z00000X , with the licence number: 750050 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X , with the licence number: 100686 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BP3500X , with the licence number: 100686 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 12503652 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 43020726 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1233760001 . This is a "PART B SUPPLIER NUMBER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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