Healthcare Provider Details

I. General information

NPI: 1164422945
Provider Name (Legal Business Name): BUTLER REST HOME, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 08/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 TAYLOR LN
BUTLER KY
41006-8550
US

IV. Provider business mailing address

PO BOX 402
BUTLER KY
41006-0402
US

V. Phone/Fax

Practice location:
  • Phone: 859-472-2217
  • Fax: 859-472-5869
Mailing address:
  • Phone: 859-472-2217
  • Fax: 859-472-5869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number100362
License Number StateKY

VIII. Authorized Official

Name: MR. KENNETH URLAGE
Title or Position: ADMINISTRATOR
Credential: B.S. BUSINESS ADMINI
Phone: 859-472-2217