Healthcare Provider Details

I. General information

NPI: 1376767335
Provider Name (Legal Business Name): RESIDENTIAL CARE CENTER OF PADUCAH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 IRVIN COBB DR
PADUCAH KY
42003-6447
US

IV. Provider business mailing address

2301 IRVIN COBB DR
PADUCAH KY
42003-6447
US

V. Phone/Fax

Practice location:
  • Phone: 270-442-6441
  • Fax: 270-442-0283
Mailing address:
  • Phone: 270-442-6441
  • Fax: 270-442-0283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number100626
License Number StateKY

VIII. Authorized Official

Name: MR. RANDALL SHELBY
Title or Position: ADMINISTRATOR
Credential:
Phone: 270-442-6441