Healthcare Provider Details

I. General information

NPI: 1114964905
Provider Name (Legal Business Name): KENTUCKY MEDICAL INVESTORS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 06/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 N HIGHWAY 11
MANCHESTER KY
40962-5478
US

IV. Provider business mailing address

3001 KEITH ST NW
CLEVELAND TN
37312-3713
US

V. Phone/Fax

Practice location:
  • Phone: 606-598-6163
  • Fax: 606-598-6154
Mailing address:
  • Phone: 423-473-5751
  • Fax: 423-339-8342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number100502
License Number StateKY

VIII. Authorized Official

Name: CINDY S CROSS
Title or Position: ASST. SECRETARY FOR LCCA, MANAGER
Credential:
Phone: 423-473-5867