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General NPI Number Information
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NPI Number | 1669543716
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Entity Type | Organization
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Legal Business Name | BEAVER DAM NURSING & REHAB CENTER, INC
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Dates
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Enumeration Date | 11/12/2006
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Last Update Date | 08/18/2015
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Provider Practice Location Address
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Address Line | 1595 US HIGHWAY 231 S
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City | BEAVER DAM
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State | KY
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Zip | 42320-9463
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Country | US
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Telephone | 270-274-9646
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Fax |
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Provider Business Mailing Address
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Address Line | 1595 US HIGHWAY 231 S
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City | BEAVER DAM
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State | KY
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Zip | 42320-9463
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Country | US
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Telephone | 270-274-9646
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DOUGLAS P COX
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Credential |
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Telephone | 615-478-6181
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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 | 100353
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License Number State | KY
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