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General NPI Number Information
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NPI Number | 1851338784
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Entity Type | Organization
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Legal Business Name | HURSTBOURNE HEALTHCARE LLC
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Dates
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Enumeration Date | 05/31/2006
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Last Update Date | 01/22/2016
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Provider Practice Location Address
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Address Line | 2200 STONY BROOK DR
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City | LOUISVILLE
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State | KY
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Zip | 40220-4016
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Country | US
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Telephone | 502-495-6240
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Fax | 502-495-0324
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Provider Business Mailing Address
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Address Line | 2200 STONY BROOK DR
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City | LOUISVILLE
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State | KY
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Zip | 40220-4016
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Country | US
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Telephone | 502-495-6240
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Fax | 502-495-0324
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Authorized Official
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Title or Position | MANAGER
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Name | ROY T. BABER
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Credential |
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Telephone | 502-495-6240
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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 | 100645 PCH
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 100645 NF
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License Number State | KY
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