Healthcare Provider Details

I. General information

NPI: 1609905272
Provider Name (Legal Business Name): HYDEN NURSING HOME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 05/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21040 US 421 SOUTH
HYDEN KY
41749
US

IV. Provider business mailing address

PO BOX 618
HYDEN KY
41749-0618
US

V. Phone/Fax

Practice location:
  • Phone: 606-672-2940
  • Fax: 606-672-4167
Mailing address:
  • Phone: 606-672-2940
  • Fax: 606-672-4167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number100624
License Number StateKY

VIII. Authorized Official

Name: MR. TERRY EMANUEL FORCHT
Title or Position: MEMBER
Credential:
Phone: 606-528-9600