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General NPI Number Information
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NPI Number | 1902250012
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Entity Type | Organization
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Legal Business Name | JACKSON MANOR LLC
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Dates
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Enumeration Date | 04/15/2016
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Last Update Date | 04/15/2016
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Provider Practice Location Address
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Address Line | 96 HIGHWAY 3444
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City | ANNVILLE
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State | KY
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Zip | 40402-8245
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Country | US
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Telephone | 502-714-7444
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Fax |
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Provider Business Mailing Address
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Address Line | 700 N HURSTBOURNE PKWY
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City | LOUISVILLE
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State | KY
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Zip | 40222-5393
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Country | US
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Telephone | 502-714-7444
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE VICE PRESIDENT
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Name | MRS. ROBIN BARBER
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Credential |
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Telephone | 502-714-7444
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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 |
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License Number State |
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