| NPI | 1124456389 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRANCE DILLON Assistant Secretary 502-596-7220 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: TN 0000000165) |
| Additional Taxonomies | 313M00000X Nursing Facility/Intermediate Care Facility (Licence: TN 0000000165) |
| Enumeration Date | 2013-10-28 |
| Last Update Date | 2022-04-25 |