Healthcare Provider Details

I. General information

NPI: 1770509770
Provider Name (Legal Business Name): BOURBON HEIGHTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 07/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 MAIN ST
PARIS KY
40361-1149
US

IV. Provider business mailing address

2000 MAIN ST
PARIS KY
40361-1149
US

V. Phone/Fax

Practice location:
  • Phone: 859-987-0065
  • Fax: 859-987-6460
Mailing address:
  • Phone: 859-987-5750
  • Fax: 859-987-6460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number750139
License Number StateKY

VIII. Authorized Official

Name: MRS. CHARLOTTE LEE ROBERTS
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 859-987-5750