MEDICARE: SANSBURY CARE CENTER, 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	314000000X	Skilled Nursing Facility		KY
2	314000000X	Skilled Nursing Facility	100505	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	:	1568495059
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANSBURY CARE CENTER, INC.

Provider Business Mailing Address
First Line	:	2625 BARDSTOWN ROAD
Second Line	:
City	:	ST CATHARINE
State	:	KY
Zip	:	40061-9435
Country	:	US
Telephone Number	:	859-336-3974
Fax Number	:	859-336-9306

Provider Business Practice Location Address
First Line	:	2625 BARDSTOWN ROAD
Second Line	:
City	:	ST CATHARINE
State	:	KY
Zip	:	40061-9435
Country	:	US
Telephone Number	:	859-336-3974
Fax Number	:	859-336-9306

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	DARLENE HERALD
Credential	:
Telephone Number	:	859-336-3974

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	10/24/2008

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