Provider Demographics
NPI:1023029428
Name:CENTRAL CITY ENTERPRISES INC.
Entity Type:Organization
Organization Name:CENTRAL CITY ENTERPRISES INC.
Other - Org Name:BELLE MEADE HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:CORP SECRETARY/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:MURIEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCROY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-338-1541
Mailing Address - Street 1:521 GREENE DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42345-1409
Mailing Address - Country:US
Mailing Address - Phone:270-338-1541
Mailing Address - Fax:270-338-4367
Practice Address - Street 1:521 GREENE DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:KY
Practice Address - Zip Code:42345-1409
Practice Address - Country:US
Practice Address - Phone:270-338-1541
Practice Address - Fax:270-338-4367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100342313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY12500047Medicaid
KY185317Medicare ID - Type Unspecified