MEDICARE: MOUNT WASHINGTON HEALTH CARE LLC

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	251J00000X	Nursing Care Agency

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	:	1609961820
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNT WASHINGTON HEALTH CARE LLC

Provider Business Mailing Address
First Line	:	310 BOXWOOD RUN RD
Second Line	:
City	:	MT WASHINGTON
State	:	KY
Zip	:	40047-7143
Country	:	US
Telephone Number	:	520-538-3500
Fax Number	:	502-955-7395

Provider Business Practice Location Address
First Line	:	310 BOXWOOD RUN
Second Line	:
City	:	MT WASHINGTON
State	:	KY
Zip	:	40047-7143
Country	:	US
Telephone Number	:	520-538-3500
Fax Number	:	502-955-7395

Authorized Official
Title or Position	:	VICE PRES
Name	:	MR. JAMES T SLEADD
Credential	:
Telephone Number	:	502-254-5464

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	09/18/2009

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