Healthcare Provider Details

I. General information

NPI: 1669016010
Provider Name (Legal Business Name): LYNDON WOODS CARE & REHAB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2019
Last Update Date: 02/04/2020
Certification Date: 02/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 LYNDON LN
LOUISVILLE KY
40222-4317
US

IV. Provider business mailing address

1050 CHINOE RD STE 350
LEXINGTON KY
40502-6571
US

V. Phone/Fax

Practice location:
  • Phone: 502-425-0331
  • Fax: 502-410-0630
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