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General NPI Number Information
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NPI Number | 1285186924
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Entity Type | Organization
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Legal Business Name | PIONEER TRACE GROUP, LLC
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Dates
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Enumeration Date | 10/28/2016
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Last Update Date | 11/01/2016
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Provider Practice Location Address
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Address Line | 115 PIONEER TRCE
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City | FLEMINGSBURG
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State | KY
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Zip | 41041-9665
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Country | US
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Telephone | 606-845-2131
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Fax | 606-845-3507
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Provider Business Mailing Address
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Address Line | 115 PIONEER TRCE
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City | FLEMINGSBURG
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State | KY
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Zip | 41041-9665
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Country | US
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Telephone | 606-845-2131
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Fax | 606-845-3507
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Authorized Official
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Title or Position | CFO/MEMBER
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Name | MRS. KIMBERLY SMITH
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Credential | NHA
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Telephone | 270-839-1589
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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 | 100484
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License Number State | KY
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