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General NPI Number Information
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NPI Number | 1295789295
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Entity Type | Organization
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Legal Business Name | 1300 CAMPBELL LANE OPERATING COMPANY LLC
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Dates
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Enumeration Date | 05/22/2006
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 1300 CAMPBELL LN
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City | BOWLING GREEN
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State | KY
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Zip | 42104-4162
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Country | US
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Telephone | 270-782-6900
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Fax | 270-782-7228
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Provider Business Mailing Address
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Address Line | PO BOX 26657
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City | FRESNO
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State | CA
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Zip | 93729-6657
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Country | US
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Telephone | 559-892-2500
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Fax | 559-892-2444
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. BRAD EUGENE HOLLINGER
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Credential |
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Telephone | 717-591-5700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283X00000X
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Taxonomy Name | Rehabilitation Hospital
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License Number | 100655
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License Number State | KY
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