MEDICARE: LP TOMPKINSVILLE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1801266085
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LP TOMPKINSVILLE, LLC

Provider Business Mailing Address
First Line	:	12201 BLUEGRASS PKWY
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40299-2361
Country	:	US
Telephone Number	:	502-568-7800
Fax Number	:	502-804-3734

Provider Business Practice Location Address
First Line	:	706 N MAGNOLIA ST
Second Line	:
City	:	TOMPKINSVILLE
State	:	KY
Zip	:	42167-1112
Country	:	US
Telephone Number	:	270-487-6135
Fax Number	:	270-487-8604

Authorized Official
Title or Position	:	CFO
Name	:	MR. JOHN HARRISON
Credential	:
Telephone Number	:	502-568-7800

Provider Enumeration Date	:	10/01/2015
Last Update Date	:	04/04/2023

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