Healthcare Provider Details

I. General information

NPI: 1366431975
Provider Name (Legal Business Name): WHITLEY COUNTY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 11/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

192 BACON CREEK RD
CORBIN KY
40701-8639
US

IV. Provider business mailing address

300 PROVIDER CT
RICHMOND KY
40475-8488
US

V. Phone/Fax

Practice location:
  • Phone: 606-526-1900
  • Fax: 606-526-9892
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 Number100771
License Number StateKY

VIII. Authorized Official

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