Healthcare Provider Details

I. General information

NPI: 1295773786
Provider Name (Legal Business Name): BROWNSBORO HILLS HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 07/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2141 SYCAMORE AVE
LOUISVILLE KY
40206-2013
US

IV. Provider business mailing address

2141 SYCAMORE AVE
LOUISVILLE KY
40206-2013
US

V. Phone/Fax

Practice location:
  • Phone: 502-895-5417
  • Fax: 502-895-3706
Mailing address:
  • Phone: 502-895-5417
  • Fax: 502-895-3706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number100197 NH
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number100197 NF
License Number StateKY

VIII. Authorized Official

Name: THOMAS C. RAWLINS
Title or Position: MANAGER
Credential:
Phone: 502-895-5417