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General NPI Number Information
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NPI Number | 1669542825
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Entity Type | Organization
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Legal Business Name | BREATITT COUNTY GERIATRIC CORPORATION
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 07/17/2008
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Provider Practice Location Address
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Address Line | 420 JETT DR
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City | JACKSON
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State | KY
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Zip | 41339-9621
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Country | US
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Telephone | 606-666-2456
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Fax | 606-666-9376
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Provider Business Mailing Address
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Address Line | 420 JETT DR
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City | JACKSON
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State | KY
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Zip | 41339-9621
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Country | US
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Telephone | 606-666-2456
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Fax | 606-666-9376
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. PHILLIP LITTERAL
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Credential |
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Telephone | 606-666-2456
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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 | KY100040
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | KY100040
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License Number State | KY
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