Healthcare Provider Details

I. General information

NPI: 1750493151
Provider Name (Legal Business Name): WILLIAMSBURG NURSING HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 05/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

287 N 11TH ST
WILLIAMSBURG KY
40769-1759
US

IV. Provider business mailing address

PO BOX 719
WILLIAMSBURG KY
40769-0719
US

V. Phone/Fax

Practice location:
  • Phone: 606-549-4321
  • Fax: 606-549-4324
Mailing address:
  • Phone: 606-549-4321
  • Fax: 606-549-4324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number100488
License Number StateKY

VIII. Authorized Official

Name: MR. TERRY EMANUEL FORCHT
Title or Position: CHAIRMAN
Credential:
Phone: 606-528-9600