=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497015671
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RICHMOND HEALTH FACILITIES - KENWOOD LP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2012
-----------------------------------------------------
Last Update Date | 05/24/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 130 MEADOWLARK DR
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40475-2238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-623-9472
-----------------------------------------------------
Fax | 859-625-3065
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5420 W PLANO PKWY
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75093-4823
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-931-3800
-----------------------------------------------------
Fax | 972-767-6222
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF REIMBURSEMENT
-----------------------------------------------------
Name | MRS. JAMIE L COLLIER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 972-931-3800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------