Healthcare Provider Details

I. General information

NPI: 1629296306
Provider Name (Legal Business Name): ROLLINS BEDFORD CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 04/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

683 E 3RD ST
RUSSELLVILLE KY
42276-1872
US

IV. Provider business mailing address

602 COURTLAND ST SUITE 200
ORLANDO FL
32804-1360
US

V. Phone/Fax

Practice location:
  • Phone: 270-726-9049
  • Fax: 270-726-8706
Mailing address:
  • Phone: 407-975-3000
  • Fax: 407-975-3090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number100299
License Number StateKY

VIII. Authorized Official

Name: MR. RONALD M WEHTJE
Title or Position: VP CFO
Credential:
Phone: 407-975-3010