Healthcare Provider Details

I. General information

NPI: 1689627424
Provider Name (Legal Business Name): HIGHLANDS NURSING AND REHABILITATION CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 07/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 STEVENS AVE
LOUISVILLE KY
40205-1044
US

IV. Provider business mailing address

1705 STEVENS AVE
LOUISVILLE KY
40205-1044
US

V. Phone/Fax

Practice location:
  • Phone: 502-451-7330
  • Fax:
Mailing address:
  • Phone: 502-451-7330
  • Fax: 502-238-5240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number100218
License Number StateKY

VIII. Authorized Official

Name: MARIA ELVA GONZALEZ
Title or Position: CFO
Credential:
Phone: 786-385-4364