=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881620490
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAYRE CHRISTIAN VILLAGE NURSING HOME, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/24/2006
-----------------------------------------------------
Last Update Date | 02/13/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3775 BELLEAU WOOD DR
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40517-1804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-271-9000
-----------------------------------------------------
Fax | 859-271-8160
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3775 BELLEAU WOOD DR
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40517-1804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-271-9000
-----------------------------------------------------
Fax | 859-271-8160
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BUSINESS OFFICE
-----------------------------------------------------
Name | DAWN M DAVIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 859-271-9000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 100544
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------