Healthcare Provider Details

I. General information

NPI: 1093350233
Provider Name (Legal Business Name): FARTHING MAYFIELD KY OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2019
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 W FARTHING ST
MAYFIELD KY
42066-2900
US

IV. Provider business mailing address

2100 CHEROKEE RIDGE WAY STE 100
LOUISVILLE KY
40205-1600
US

V. Phone/Fax

Practice location:
  • Phone: 270-247-6477
  • Fax:
Mailing address:
  • Phone: 502-667-8150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MICK VUJANOVIC
Title or Position: CEO
Credential:
Phone: 502-667-8150