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General NPI Number Information
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NPI Number | 1669495131
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Entity Type | Organization
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Legal Business Name | MASONIC HOMES OF KENTUCKY INC
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 12/22/2008
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Provider Practice Location Address
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Address Line | 711 FRANKFORT RD
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City | SHELBYVILLE
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State | KY
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Zip | 40065-9447
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Country | US
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Telephone | 502-633-3486
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Fax | 502-633-0661
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Provider Business Mailing Address
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Address Line | 711 FRANKFORT RD P.O. BOX 909
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City | SHELBYVILLE
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State | KY
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Zip | 40065-9447
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Country | US
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Telephone | 502-633-3486
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Fax | 502-633-0661
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. DEBRA FINNERAN
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Credential | R.N.
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Telephone | 502-633-3486
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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 | 100386
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License Number State | KY
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