Healthcare Provider Details

I. General information

NPI: 1821081555
Provider Name (Legal Business Name): ST CHARLES CARE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2005
Last Update Date: 08/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 FARRELL DR
COVINGTON KY
41011-5126
US

IV. Provider business mailing address

600 FARRELL DR
COVINGTON KY
41011-5126
US

V. Phone/Fax

Practice location:
  • Phone: 859-331-3224
  • Fax: 859-292-1670
Mailing address:
  • Phone: 859-331-3224
  • Fax: 859-292-1670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number101185
License Number StateKY

VIII. Authorized Official

Name: MS. NANCY J CAMPBELL
Title or Position: CFO
Credential:
Phone: 859-331-3224