Healthcare Provider Details

I. General information

NPI: 1962780809
Provider Name (Legal Business Name): REDBANKS COLONIAL TERRACE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2011
Last Update Date: 05/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 ROGER POWELL RD
SEBREE KY
42455-2115
US

IV. Provider business mailing address

142 ROGER POWELL RD
SEBREE KY
42455-2115
US

V. Phone/Fax

Practice location:
  • Phone: 270-835-2533
  • Fax:
Mailing address:
  • Phone: 270-835-2533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number100440
License Number StateKY

VIII. Authorized Official

Name: MR. CHRIS PAGE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 270-826-6436