Basic Information
| Provider Information | |||||||||
| NPI: | 1386196939 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MIDDLESBORO OPERATIONS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 PROVIDER CT | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | KY | ||||||||
| PostalCode: | 404758488 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8596230898 | ||||||||
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| Practice Location | |||||||||
| Address1: | 235 NEW WILSON LN | ||||||||
| Address2: | |||||||||
| City: | MIDDLESBORO | ||||||||
| State: | KY | ||||||||
| PostalCode: | 409652705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8596230898 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2016 | ||||||||
| LastUpdateDate: | 06/16/2017 | ||||||||
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| AuthorizedOfficialLastName: | LANDA | ||||||||
| AuthorizedOfficialFirstName: | BENJAMIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGING MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 5168693700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.