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General NPI Number Information
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NPI Number | 1295724086
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Entity Type | Organization
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Legal Business Name | NEW JEFFERSON MANOR, LLC
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Dates
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Enumeration Date | 10/14/2005
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Last Update Date | 04/01/2014
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Provider Practice Location Address
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Address Line | 1801 LYNN WAY
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City | LOUISVILLE
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State | KY
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Zip | 40222-6552
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Country | US
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Telephone | 502-426-4513
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Fax | 502-426-7041
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Provider Business Mailing Address
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Address Line | 1801 LYNN WAY
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City | LOUISVILLE
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State | KY
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Zip | 40222-6552
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Country | US
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Telephone | 502-426-4513
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Fax | 502-426-7041
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. JIM MORRIS
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Credential |
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Telephone | 502-426-4513
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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 | 100533
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License Number State | KY
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