MEDICARE: BEDROCK HC AT GREEN MEADOWS LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QH0700X	Hearing and Speech Clinic/Center
2	261QP2000X	Physical Therapy Clinic/Center
3	261QX0100X	Occupational Medicine Clinic/Center
4	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1730645771
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEDROCK HC AT GREEN MEADOWS LLC

Provider Business Mailing Address
First Line	:	310 BOXWOOD RUN
Second Line	:
City	:	MOUNT WASHINGTON
State	:	KY
Zip	:	40047-7143
Country	:	US
Telephone Number	:	502-955-7600
Fax Number	:	502-995-7395

Provider Business Practice Location Address
First Line	:	310 BOXWOOD RUN
Second Line	:
City	:	MOUNT WASHINGTON
State	:	KY
Zip	:	40047-7143
Country	:	US
Telephone Number	:	502-955-7600
Fax Number	:	502-995-7395

Authorized Official
Title or Position	:	MANAGER
Name	:	KENNETH D NICHOLS
Credential	:
Telephone Number	:	813-777-4663

Provider Enumeration Date	:	02/14/2019
Last Update Date	:	07/24/2019

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