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General NPI Number Information
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NPI Number | 1730645771
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Entity Type | Organization
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Legal Business Name | BEDROCK HC AT GREEN MEADOWS LLC
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Dates
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Enumeration Date | 02/14/2019
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Last Update Date | 07/24/2019
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Provider Practice Location Address
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Address Line | 310 BOXWOOD RUN
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City | MOUNT WASHINGTON
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State | KY
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Zip | 40047-7143
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Country | US
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Telephone | 502-955-7600
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Fax | 502-995-7395
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Provider Business Mailing Address
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Address Line | 310 BOXWOOD RUN
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City | MOUNT WASHINGTON
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State | KY
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Zip | 40047-7143
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Country | US
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Telephone | 502-955-7600
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Fax | 502-995-7395
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Authorized Official
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Title or Position | MANAGER
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Name | KENNETH D NICHOLS
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Credential |
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Telephone | 813-777-4663
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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