Healthcare Provider Details

I. General information

NPI: 1700989043
Provider Name (Legal Business Name): HBR WOODBURN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 01/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 S COLLEGE
WOODBURN KY
42170-9638
US

IV. Provider business mailing address

101 SUN AVE NE COMPLIANCE DEPARTMENT
ALBUQUERQUE NM
87109-4373
US

V. Phone/Fax

Practice location:
  • Phone: 270-529-2853
  • Fax: 270-529-9836
Mailing address:
  • Phone: 505-468-5604
  • Fax: 505-468-4681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: THOMAS DIVITTORIO
Title or Position: CFO, TREASURER, ASST SECRETARY
Credential:
Phone: 505-468-4742