Healthcare Provider Details

I. General information

NPI: 1700077070
Provider Name (Legal Business Name): LP BEDFORD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 10/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 SHEPHERD LN
BEDFORD KY
40006-8809
US

IV. Provider business mailing address

12201 BLUEGRASS PKWY
LOUISVILLE KY
40299-2361
US

V. Phone/Fax

Practice location:
  • Phone: 502-255-3244
  • Fax: 502-255-7844
Mailing address:
  • Phone: 502-568-7800
  • Fax: 502-568-7150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number100506
License Number StateKY

VIII. Authorized Official

Name: MR. JOHN HARRISON
Title or Position: CFO
Credential:
Phone: 502-568-7800