Healthcare Provider Details

I. General information

NPI: 1861481533
Provider Name (Legal Business Name): SUMMIT MANOR HEALTH & REHABILITATION CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 09/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 BOMAR HTS
COLUMBIA KY
42728-1511
US

IV. Provider business mailing address

400 BOMAR HTS
COLUMBIA KY
42728-1511
US

V. Phone/Fax

Practice location:
  • Phone: 270-384-2153
  • Fax: 270-384-3964
Mailing address:
  • Phone: 270-384-2153
  • Fax: 270-384-3964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number100003
License Number StateKY

VIII. Authorized Official

Name: MS. MARCELLA HODGES
Title or Position: ADMINISTRATOR
Credential:
Phone: 270-384-2153