Healthcare Provider Details

I. General information

NPI: 1477101889
Provider Name (Legal Business Name): PHELPS KY OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2019
Last Update Date: 02/08/2023
Certification Date: 02/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 PHILLIPS BRANCH RD
PHELPS KY
41553-9061
US

IV. Provider business mailing address

1449 37TH ST STE 605
BROOKLYN NY
11218-4380
US

V. Phone/Fax

Practice location:
  • Phone: 646-649-1131
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: DAVID HERSKOWITZ
Title or Position: CEO
Credential:
Phone: 212-444-1991