Healthcare Provider Details

I. General information

NPI: 1770865263
Provider Name (Legal Business Name): LP HODGENVILLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2011
Last Update Date: 04/03/2023
Certification Date: 04/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 N LINCOLN BLVD
HODGENVILLE KY
42748-1622
US

IV. Provider business mailing address

717 N LINCOLN BLVD
HODGENVILLE KY
42748-1622
US

V. Phone/Fax

Practice location:
  • Phone: 270-358-3103
  • Fax:
Mailing address:
  • Phone: 270-358-3103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number750086
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number100277
License Number StateKY

VIII. Authorized Official

Name: JOHN HARRISON
Title or Position: CFO
Credential:
Phone: 502-568-7800