Healthcare Provider Details

I. General information

NPI: 1194786632
Provider Name (Legal Business Name): BAPTIST CONVALESCENT CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 09/06/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 HIGHLAND AVE SUITE 30
FT WRIGHT KY
41011-4001
US

IV. Provider business mailing address

800 HIGHLAND AVE SUITE 30
FT WRIGHT KY
41011-4001
US

V. Phone/Fax

Practice location:
  • Phone: 859-547-3353
  • Fax: 859-547-3344
Mailing address:
  • Phone: 859-547-3353
  • Fax: 859-547-3344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number150180
License Number StateKY

VIII. Authorized Official

Name: DR. ROBERT LONG
Title or Position: CEO
Credential: PHD
Phone: 859-491-3800