1104828383 NPI number — BRECKINRIDGE HEALTH, INC

Table of content: (NPI 1104828383)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104828383 NPI number — BRECKINRIDGE HEALTH, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRECKINRIDGE HEALTH, 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:
Provider Other Organization Name Type Code:
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:
1104828383
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1011 OLD HIGHWAY 60
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARDINSBURG
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40143-2519
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-756-6569
Provider Business Mailing Address Fax Number:
270-580-2208

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1011 OLD HIGHWAY 60
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARDINSBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40143-2519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-756-7000
Provider Business Practice Location Address Fax Number:
270-580-2208
Provider Enumeration Date:
06/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
PORTMAN
Authorized Official First Name:
ANGELA
Authorized Official Middle Name:
FAYE
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
270-756-6569

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X , with the licence number:  600070 , 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: 000000069148 . This is a "BLUE SHIELD" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1041597 . This is a "PASSPORT" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 185285 . This is a "SNF" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 12503173 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000054573 . This is a "BLUE CROSS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 01015932 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 18Z319 . This is a "MEDICARE SWING BED" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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