Healthcare Provider Details

I. General information

NPI: 1700978806
Provider Name (Legal Business Name): J & R LAGRANGE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 RICHWOOD WAY
LAGRANGE KY
40031-8930
US

IV. Provider business mailing address

1012 RICHWOOD WAY
LAGRANGE KY
40031-8930
US

V. Phone/Fax

Practice location:
  • Phone: 502-222-3186
  • Fax: 502-222-6535
Mailing address:
  • Phone: 502-222-3186
  • Fax: 502-222-6535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number100818
License Number StateKY
# 5
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number100818
License Number StateKY
# 6
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number100818
License Number StateKY
# 8
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number100818
License Number StateKY

VIII. Authorized Official

Name: MARK BOWMAN
Title or Position: PRESIDENT
Credential:
Phone: 859-272-6682