=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164311098
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEXINGTON SNF OPERATIONS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/03/2025
-----------------------------------------------------
Last Update Date | 08/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2770 PALUMBO DR
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40509-1232
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-263-2410
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2770 PALUMBO DR
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40509-1232
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-263-2410
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUTHORIZED SIGNATORY
-----------------------------------------------------
Name | YISROEL CHAFETZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 516-504-9797
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------