Healthcare Provider Details

I. General information

NPI: 1851331672
Provider Name (Legal Business Name): TRADEWATER POINTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W RAMSEY ST
DAWSON SPRINGS KY
42408-1739
US

IV. Provider business mailing address

100 W RAMSEY ST
DAWSON SPRINGS KY
42408-1739
US

V. Phone/Fax

Practice location:
  • Phone: 270-797-8131
  • Fax: 270-797-3428
Mailing address:
  • Phone: 270-797-8131
  • Fax: 270-797-3428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number100436
License Number StateKY

VIII. Authorized Official

Name: DANNY FRANCES
Title or Position: CEO/OWNER
Credential:
Phone: 270-886-5441