Healthcare Provider Details

I. General information

NPI: 1669543716
Provider Name (Legal Business Name): BEAVER DAM NURSING & REHAB CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2006
Last Update Date: 08/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1595 US HIGHWAY 231 S
BEAVER DAM KY
42320-9463
US

IV. Provider business mailing address

1595 US HIGHWAY 231 S
BEAVER DAM KY
42320-9463
US

V. Phone/Fax

Practice location:
  • Phone: 270-274-9646
  • Fax:
Mailing address:
  • Phone: 270-274-9646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number100353
License Number StateKY

VIII. Authorized Official

Name: DOUGLAS P COX
Title or Position: PRESIDENT
Credential:
Phone: 615-478-6181