Healthcare Provider Details

I. General information

NPI: 1942579701
Provider Name (Legal Business Name): SOMERVIEW PERSONAL CARE HOME, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2011
Last Update Date: 12/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 N MAIN ST
SOMERSET KY
42501-1405
US

IV. Provider business mailing address

PO BOX 1103
SOMERSET KY
42502-1103
US

V. Phone/Fax

Practice location:
  • Phone: 606-678-0440
  • Fax: 606-679-6515
Mailing address:
  • Phone: 606-678-0440
  • Fax: 606-679-6515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number100369
License Number StateKY

VIII. Authorized Official

Name: MELISSA CHRISTINE CREEKMORE
Title or Position: CORPORATE OFFICER
Credential:
Phone: 606-678-8927