Healthcare Provider Details

I. General information

NPI: 1225027840
Provider Name (Legal Business Name): BEREA AREA DEVELOPMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 04/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1043 BROOKLYN BLVD
BEREA KY
40403-1090
US

IV. Provider business mailing address

300 PROVIDER CT SUITE 100
RICHMOND KY
40475-8488
US

V. Phone/Fax

Practice location:
  • Phone: 859-228-0551
  • Fax: 859-228-6334
Mailing address:
  • Phone: 859-623-0898
  • Fax: 859-623-0843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number100737
License Number StateKY

VIII. Authorized Official

Name: MRS. KIMBERLY MORROW
Title or Position: VP OF ADMINISTRATIVE SUPPORT
Credential:
Phone: 859-623-0898