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General NPI Number Information
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NPI Number | 1154341923
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Entity Type | Organization
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Legal Business Name | MASONIC HOMES OF KENTUCKY INC
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Dates
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Enumeration Date | 07/21/2006
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Last Update Date | 10/14/2011
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Provider Practice Location Address
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Address Line | 240 MASONIC HOME DR
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City | MASONIC HOME
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State | KY
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Zip | 40041-9000
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Country | US
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Telephone | 502-897-4907
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Fax | 502-259-5290
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Provider Business Mailing Address
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Address Line | 240 MASONIC HOME DR
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City | MASONIC HOME
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State | KY
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Zip | 40041-9000
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Country | US
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Telephone | 502-897-4907
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Fax | 502-259-5290
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Authorized Official
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Title or Position | CFO
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Name | MR. TODD L. LACY
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Credential |
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Telephone | 502-753-8802
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number | 760006
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 100225
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License Number State | KY
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