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General NPI Number Information
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NPI Number | 1083697452
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Entity Type | Organization
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Legal Business Name | MT. LEBANON PERSONAL CARE HOME INC.
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Dates
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Enumeration Date | 11/21/2005
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Last Update Date | 07/17/2008
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Provider Practice Location Address
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Address Line | 1015 MAGAZINE STREET
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City | LOUISVILLE
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State | KY
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Zip | 40203
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Country | US
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Telephone | 502-589-0727
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Fax | 502-589-3086
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Provider Business Mailing Address
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Address Line | 1015 MAGAZINE STREET
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City | LOUISVILLE
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State | KY
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Zip | 40203
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Country | US
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Telephone | 502-589-0727
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Fax | 502-589-3086
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MS. REGINA LOUISE LYONS
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Credential | CMA, CFO
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Telephone | 502-589-0727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 100536
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License Number State | KY
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