Healthcare Provider Details

I. General information

NPI: 1730645771
Provider Name (Legal Business Name): BEDROCK HC AT GREEN MEADOWS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2019
Last Update Date: 07/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 BOXWOOD RUN
MOUNT WASHINGTON KY
40047-7143
US

IV. Provider business mailing address

310 BOXWOOD RUN
MOUNT WASHINGTON KY
40047-7143
US

V. Phone/Fax

Practice location:
  • Phone: 502-955-7600
  • Fax: 502-995-7395
Mailing address:
  • Phone: 502-955-7600
  • Fax: 502-995-7395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: KENNETH D NICHOLS
Title or Position: MANAGER
Credential:
Phone: 813-777-4663