Healthcare Provider Details

I. General information

NPI: 1396389748
Provider Name (Legal Business Name): ST. MATTHEWS CARE AND REHAB CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2019
Last Update Date: 10/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 BROWNS LN
LOUISVILLE KY
40207-3215
US

IV. Provider business mailing address

1050 CHINOE RD STE 350
LEXINGTON KY
40502-6571
US

V. Phone/Fax

Practice location:
  • Phone: 502-893-2595
  • Fax: 502-526-5960
Mailing address:
  • Phone: 859-255-0075
  • Fax: 859-281-5150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BRENDA CAMPBELL
Title or Position: AR BILLING MANAGER
Credential:
Phone: 859-255-0075