MEDICARE: OH MUHLENBERG, 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	314000000X	Skilled Nursing Facility	100734	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649225210
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OH MUHLENBERG, LLC

Provider Business Mailing Address
First Line	:	440 HOPKINSVILLE ST
Second Line	:	PO BOX 387
City	:	GREENVILLE
State	:	KY
Zip	:	42345-1124
Country	:	US
Telephone Number	:	270-338-8000
Fax Number	:	270-338-8278

Provider Business Practice Location Address
First Line	:	440 HOPKINSVILLE ST
Second Line	:
City	:	GREENVILLE
State	:	KY
Zip	:	42345-1124
Country	:	US
Telephone Number	:	270-338-8000
Fax Number	:	270-338-8278

Authorized Official
Title or Position	:	TREASURER
Name	:	MR. JOHN HACKBARTH JR.
Credential	:
Telephone Number	:	270-417-2000

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	01/04/2018

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1407800436 — OH MUHLENBERG, LLC
Practice Location Address:

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42345-1124

Practice Phone: 270-338-8000
Practice Fax: 270-338-8278

Directions to “OH MUHLENBERG, LLC ” Practice Location

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