Basic Information
| Provider Information | |||||||||
| NPI: | 1689975757 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WESTON REHABILITATION KENTUCKY LLC | ||||||||
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| OtherOrganizationName: | ATRIA HIGHLAND CROSSING | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3131 ELLIOTT AVE | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981211031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062982909 | ||||||||
| FaxNumber: | 2063014500 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 FARRELL DRIVE | ||||||||
| Address2: | |||||||||
| City: | FORT WRIGHT | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410113785 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593410777 | ||||||||
| FaxNumber: | 8593411381 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2010 | ||||||||
| LastUpdateDate: | 11/05/2010 | ||||||||
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| AuthorizedOfficialLastName: | COBB | ||||||||
| AuthorizedOfficialFirstName: | GRANGER | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2062982909 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 235Z00000X | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 225100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.