Provider Demographics
NPI:1053300715
Name:RICHMOND KENWOOD HEALTH & REHABILITATION COMPLEX, LLC
Entity Type:Organization
Organization Name:RICHMOND KENWOOD HEALTH & REHABILITATION COMPLEX, LLC
Other - Org Name:RICHMOND HEALTH & REHABILITATION COMPLEX- KENWOOD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:JUSTICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-623-9472
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40476-0009
Mailing Address - Country:US
Mailing Address - Phone:859-623-9472
Mailing Address - Fax:859-625-3069
Practice Address - Street 1:130 MEADOWLARK DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2238
Practice Address - Country:US
Practice Address - Phone:859-623-9472
Practice Address - Fax:859-625-3069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100321314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY18-5061Medicare ID - Type Unspecified