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General NPI Number Information
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NPI Number | 1689414294
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Entity Type | Organization
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Legal Business Name | ONE SENIOR CARE KENTUCKY, LLC
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Dates
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Enumeration Date | 05/30/2024
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Last Update Date | 05/30/2024
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Provider Practice Location Address
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Address Line | 419 TOWN MOUNTAIN RD
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City | PIKEVILLE
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State | KY
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Zip | 41501-1631
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Country | US
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Telephone | 606-727-2690
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Fax |
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Provider Business Mailing Address
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Address Line | 100 STATE ST STE 200
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City | ERIE
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State | PA
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Zip | 16507-1454
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Country | US
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Telephone | 814-456-5433
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Fax | 814-454-2500
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | JEFFERY PHILLIPS
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Credential |
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Telephone | 814-456-5433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251T00000X
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Taxonomy Name | PACE Provider Organization
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License Number |
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License Number State |
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