Healthcare Provider Details

I. General information

NPI: 1538657648
Provider Name (Legal Business Name): BRADFORD HEIGHTS OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2018
Last Update Date: 04/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 HIGHPOINT DR
HOPKINSVILLE KY
42240-2570
US

IV. Provider business mailing address

950 HIGHPOINT DR
HOPKINSVILLE KY
42240-2570
US

V. Phone/Fax

Practice location:
  • Phone: 270-885-1151
  • Fax: 270-885-7641
Mailing address:
  • Phone: 270-885-1151
  • Fax: 270-885-7641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BENT PHILIPSON
Title or Position: MANAGER
Credential:
Phone: 516-869-3700