Healthcare Provider Details

I. General information

NPI: 1023029428
Provider Name (Legal Business Name): CENTRAL CITY ENTERPRISES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 08/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 GREENE DR
GREENVILLE KY
42345-1409
US

IV. Provider business mailing address

521 GREENE DR
GREENVILLE KY
42345-1409
US

V. Phone/Fax

Practice location:
  • Phone: 270-338-1541
  • Fax: 270-338-4367
Mailing address:
  • Phone: 270-338-1541
  • Fax: 270-338-4367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number100342
License Number StateKY

VIII. Authorized Official

Name: MURIEL D MCROY
Title or Position: CORP SECRETARY/TREASURER
Credential:
Phone: 270-338-1541