Healthcare Provider Details

I. General information

NPI: 1114052057
Provider Name (Legal Business Name): KYPPEC,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 01/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 HERR LN
LOUISVILLE KY
40222-4301
US

IV. Provider business mailing address

1101 HERR LN
LOUISVILLE KY
40222-4301
US

V. Phone/Fax

Practice location:
  • Phone: 502-210-5538
  • Fax: 502-327-5098
Mailing address:
  • Phone: 502-210-5538
  • Fax: 502-327-5098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License Number760001
License Number StateKY

VIII. Authorized Official

Name: MR. LEE B ZIMMERMAN
Title or Position: PRES
Credential:
Phone: 502-210-5538