1609441955 NPI number — BRIGHTMORE HOME CARE OF KENTUCKY, LLC

Table of content: (NPI 1609441955)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609441955 NPI number — BRIGHTMORE HOME CARE OF KENTUCKY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRIGHTMORE HOME CARE OF KENTUCKY, 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:
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:
1609441955
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
614 E MAIN ST STE C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIVERTON
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82501-4460
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-856-2600
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3565 LONE OAK RD STE 3B&4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PADUCAH
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42003-5717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-709-3145
Provider Business Practice Location Address Fax Number:
270-709-3184
Provider Enumeration Date:
05/20/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LAWSON
Authorized Official First Name:
RENEE
Authorized Official Middle Name:
Authorized Official Title or Position:
COMPLIANCE DIRECTOR
Authorized Official Telephone Number:
307-856-2600

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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