Healthcare Provider Details

I. General information

NPI: 1356467666
Provider Name (Legal Business Name): BENNETTS PERSONAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 MAPLE AVE
FALMOUTH KY
41040-1113
US

IV. Provider business mailing address

PO BOX 209
FALMOUTH KY
41040-0209
US

V. Phone/Fax

Practice location:
  • Phone: 859-654-4663
  • Fax: 859-654-1765
Mailing address:
  • Phone: 859-654-4663
  • Fax: 859-654-1765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number100363
License Number StateKY

VIII. Authorized Official

Name: RHONDA H BENNETT
Title or Position: ADMINISTRATOR
Credential:
Phone: 859-654-4663