Healthcare Provider Details

I. General information

NPI: 1518956390
Provider Name (Legal Business Name): NEW PROFESSIONAL CARE HEALTH & REHABILITATION CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 09/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 E MCMURTRY AVE
HARTFORD KY
42347-1614
US

IV. Provider business mailing address

PO BOX 125
HARTFORD KY
42347-0125
US

V. Phone/Fax

Practice location:
  • Phone: 270-298-7437
  • Fax: 270-298-9137
Mailing address:
  • Phone: 270-298-7437
  • Fax: 270-298-9137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number100354
License Number StateKY

VIII. Authorized Official

Name: MR. KEN GRAVES
Title or Position: ADMINISTRATOR
Credential:
Phone: 270-298-7437