Basic Information
| Provider Information | |||||||||
| NPI: | 1205336054 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PADUCAH CENTER FOR HEALTH AND REHABILITATION, LLC | ||||||||
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| OtherOrganizationName: | PADUCAH CENTER FOR HEALTH AND REHABILITATION | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 212 2ND ST STE 501 | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087013424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7324971150 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4747 ALBEN BARKLEY DR | ||||||||
| Address2: | |||||||||
| City: | PADUCAH | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420016789 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2704449661 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/19/2018 | ||||||||
| LastUpdateDate: | 11/06/2018 | ||||||||
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| AuthorizedOfficialLastName: | HERBSTMAN | ||||||||
| AuthorizedOfficialFirstName: | MOSHE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7324971150 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 311500000X | KY | N | Nursing & Custodial Care Facilities | Alzheimer Center (Dementia Center) | 313M00000X | KY | N | Nursing & Custodial Care Facilities | Nursing Facility/Intermediate Care Facility | 385H00000X | KY | N | Respite Care Facility | Respite Care | 314000000X | KY | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.