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General NPI Number Information
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NPI Number | 1447588629
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Entity Type | Organization
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Legal Business Name | DAVCO REST HOME, LLC
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Dates
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Enumeration Date | 11/25/2009
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Last Update Date | 11/25/2009
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Provider Practice Location Address
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Address Line | 2526 W 10TH ST
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City | OWENSBORO
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State | KY
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Zip | 42301-1738
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Country | US
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Telephone | 270-684-1705
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Fax | 270-684-0963
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Provider Business Mailing Address
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Address Line | 7 WOODFORD AVE
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City | OWENSBORO
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State | KY
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Zip | 42301-0563
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Country | US
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Telephone | 270-683-5571
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Fax | 270-683-8317
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Authorized Official
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Title or Position | OWNER
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Name | MR. HARRY D SIMPSON JR.
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Credential |
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Telephone | 270-683-5571
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 100084
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License Number State |
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