Healthcare Provider Details

I. General information

NPI: 1518954486
Provider Name (Legal Business Name): CARMEL MANOR INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 03/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CARMEL MANOR ROAD
FT. THOMAS KY
41075-2395
US

IV. Provider business mailing address

100 CARMEL MANOR ROAD
FT. THOMAS KY
41075-2395
US

V. Phone/Fax

Practice location:
  • Phone: 859-781-5111
  • Fax: 859-781-2337
Mailing address:
  • Phone: 859-781-5111
  • Fax: 859-781-2337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number100056
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number100056
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number100056
License Number StateKY

VIII. Authorized Official

Name: DIANE MACK
Title or Position: ADMINISTRATOR
Credential:
Phone: 859-781-5111