MEDICARE: CARMEL MANOR 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
1	311Z00000X	Custodial Care Facility	100056	KY
2	314000000X	Skilled Nursing Facility	100056	KY
3	251J00000X	Nursing Care Agency	100056	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518954486
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARMEL MANOR INC.

Provider Business Mailing Address
First Line	:	100 CARMEL MANOR ROAD
Second Line	:
City	:	FT. THOMAS
State	:	KY
Zip	:	41075-2395
Country	:	US
Telephone Number	:	859-781-5111
Fax Number	:	859-781-2337

Provider Business Practice Location Address
First Line	:	100 CARMEL MANOR ROAD
Second Line	:
City	:	FT. THOMAS
State	:	KY
Zip	:	41075-2395
Country	:	US
Telephone Number	:	859-781-5111
Fax Number	:	859-781-2337

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	DIANE MACK
Credential	:
Telephone Number	:	859-781-5111

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	03/22/2017

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Directions to “CARMEL MANOR INC. ” Practice Location

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