Healthcare Provider Details

I. General information

NPI: 1114134103
Provider Name (Legal Business Name): MSHI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 STERLING WAY
MT STERLING KY
40353-1172
US

IV. Provider business mailing address

125 STERLING WAY
MT STERLING KY
40353-1172
US

V. Phone/Fax

Practice location:
  • Phone: 859-498-3343
  • Fax: 859-498-9769
Mailing address:
  • Phone: 859-498-3343
  • Fax: 859-498-9769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. REBECCA L COOLEY
Title or Position: ADMINISTRATOR
Credential: LSW, LNHA
Phone: 859-498-3343