NPI Code Detail JSON Logo

1205336054 NPI number — PADUCAH CENTER FOR HEALTH AND REHABILITATION, LLC

NPI Number: 1205336054
Health Care Provider/Practitioner: PADUCAH CENTER FOR HEALTH AND REHABILITATION, LLC

Information about “1205336054” NPI (PADUCAH CENTER FOR HEALTH AND REHABILITATION, LLC) exists in 1205336054 in HTML format HTML  |  1205336054 in plain Text format TXT  |  1205336054 in PDF (Portable Document Format) PDF  |  1205336054 in an XML format XML  formats.

NPI Number : 1205336054 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1205336054",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "PADUCAH CENTER FOR HEALTH AND REHABILITATION, LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2100 CHEROKEE RIDGE WAY STE 100",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LOUISVILLE",
    "MailingAddressStateName": "KY",
    "MailingAddressPostalCode": "40205-1600",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "502-667-8150",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4747 ALBEN BARKLEY DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PADUCAH",
    "PracticeLocationAddressStateName": "KY",
    "PracticeLocationAddressPostalCode": "42001-6789",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "270-444-9661",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/19/2018",
    "LastUpdateDate": "10/09/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "VUJANOVIC",
    "AuthorizedOfficialFirstName": "MICK",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "CEO",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "502-667-8150",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "311500000X",
          "TaxonomyName": "Alzheimer Center (Dementia Center)",
          "LicenseNumber": null,
          "LicenseNumberStateCode": "KY",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "313M00000X",
          "TaxonomyName": "Nursing Facility/Intermediate Care Facility",
          "LicenseNumber": null,
          "LicenseNumberStateCode": "KY",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "385H00000X",
          "TaxonomyName": "Respite Care",
          "LicenseNumber": null,
          "LicenseNumberStateCode": "KY",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "314000000X",
          "TaxonomyName": "Skilled Nursing Facility",
          "LicenseNumber": null,
          "LicenseNumberStateCode": "KY",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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