Healthcare Provider Details

I. General information

NPI: 1164403564
Provider Name (Legal Business Name): BOLSTER HEALTH CARE GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2005
Last Update Date: 03/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 PEARL ST
AUBURN KY
42206-5121
US

IV. Provider business mailing address

139 PEARL ST
AUBURN KY
42206-5121
US

V. Phone/Fax

Practice location:
  • Phone: 270-542-4111
  • Fax: 270-542-7026
Mailing address:
  • Phone: 270-542-4111
  • Fax: 270-542-7026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number100295
License Number StateKY

VIII. Authorized Official

Name: NANCY BOLSTER
Title or Position: OWNER/MEMBER
Credential: OWNER
Phone: 270-265-5321