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NPI Code Detail

MEDICARE: BOURBON HEIGHTS, INC.

MEDICARE: BOURBON HEIGHTS, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251X00000XSupports Brokerage Agency
2314000000XSkilled Nursing Facility100024KY
3313M00000XNursing Facility/Intermediate Care Facility100024KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
219401888OTHERSUMMIT WORKER'S COMP
3000000054629OTHERANTHEM BLUE CROSS BLUE SH

General Provider Information

NPI Number : 1053344457
Entity Type Code : Organization
Provider Name (Legal Business Name) : BOURBON HEIGHTS, INC.
Provider Business Mailing Address
First Line : 2000 MAIN ST
Second Line :
City : PARIS
State : KY
Zip : 40361-1149
Country : US
Telephone Number : 859-987-5750
Fax Number : 859-987-6460
Provider Business Practice Location Address
First Line : 2000 MAIN ST
Second Line :
City : PARIS
State : KY
Zip : 40361-1149
Country : US
Telephone Number : 859-987-5750
Fax Number : 859-987-6460
Authorized Official
Title or Position : ADMINISTRATOR
Name : MR. TOM DAVIS
Credential :
Telephone Number : 859-987-5750
Provider Enumeration Date : 07/09/2006
Last Update Date : 05/19/2026

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Directions to “BOURBON HEIGHTS, INC. ” Practice Location

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