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General NPI Number Information
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NPI Number | 1265515803
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Entity Type | Organization
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Legal Business Name | THE VILLAGE OF LEBANON, LLC
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 04/25/2014
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Provider Practice Location Address
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Address Line | 337 S HARRISON ST
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City | LEBANON
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State | KY
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Zip | 40033-1150
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Country | US
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Telephone | 270-692-3121
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Fax | 270-692-6217
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Provider Business Mailing Address
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Address Line | 337 S HARRISON ST
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City | LEBANON
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State | KY
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Zip | 40033-1150
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Country | US
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Telephone | 270-692-3121
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Fax | 270-692-6217
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MR. TIMOTHY BLAND GEORGE
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Credential |
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Telephone | 502-751-6823
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 100325
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License Number State | KY
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