Healthcare Provider Details

I. General information

NPI: 1578599023
Provider Name (Legal Business Name): HANGING ROCK LTC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 07/16/2021
Certification Date: 07/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 FERNDALE APARTMENTS RD
PINEVILLE KY
40977-8578
US

IV. Provider business mailing address

FERNDALE APARTMENTS ROAD
PINEVILLE KY
40977-8578
US

V. Phone/Fax

Practice location:
  • Phone: 606-337-7071
  • Fax: 606-337-1364
Mailing address:
  • Phone: 606-337-7071
  • Fax: 606-337-1364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number100496
License Number StateKY

VIII. Authorized Official

Name: GALE BOICE
Title or Position: CFO
Credential:
Phone: 252-523-9094