Healthcare Provider Details

I. General information

NPI: 1750936621
Provider Name (Legal Business Name): WURTLAND NURSING AND REHABILITATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2019
Last Update Date: 07/20/2023
Certification Date: 07/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WURTLAND AVE
WURTLAND KY
41144-1445
US

IV. Provider business mailing address

100 BOULEVARD OF AMERICAS
LAKEWOOD NJ
08701-4585
US

V. Phone/Fax

Practice location:
  • Phone: 606-836-0931
  • Fax:
Mailing address:
  • Phone: 732-961-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PAUL PRUITT
Title or Position: OFFICER
Credential:
Phone: 317-288-4029