Healthcare Provider Details

I. General information

NPI: 1235240383
Provider Name (Legal Business Name): HBR ELIZABETHTOWN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 06/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 SAINT JOHN RD
ELIZABETHTOWN KY
42701-2918
US

IV. Provider business mailing address

101 SUN AVE NE COMPLIANCE DEPARTMENT
ALBUQUERQUE NM
87109-4373
US

V. Phone/Fax

Practice location:
  • Phone: 270-769-3314
  • Fax: 270-360-1181
Mailing address:
  • Phone: 505-468-5604
  • Fax: 505-468-4681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: THOMAS DIVITTORIO
Title or Position: CFO, TREASURER, ASST SECRETARY
Credential:
Phone: 610-444-6350