Provider Demographics
NPI:1073651295
Name:RURAL EDUCATIONAL ASSOCIATION OF KENTUCKY
Entity Type:Organization
Organization Name:RURAL EDUCATIONAL ASSOCIATION OF KENTUCKY
Other - Org Name:FRIENDSHIP MANOR NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:BUTTERFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-241-8821
Mailing Address - Street 1:7400 W HIGHWAY 146
Mailing Address - Street 2:P. O. BOX 0307
Mailing Address - City:PEWEE VALLEY
Mailing Address - State:KY
Mailing Address - Zip Code:40056-9155
Mailing Address - Country:US
Mailing Address - Phone:502-241-8821
Mailing Address - Fax:502-241-4598
Practice Address - Street 1:7400 W HIGHWAY 146
Practice Address - Street 2:
Practice Address - City:PEWEE VALLEY
Practice Address - State:KY
Practice Address - Zip Code:40056-9155
Practice Address - Country:US
Practice Address - Phone:502-241-8821
Practice Address - Fax:502-241-4598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100355314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY12501599Medicaid
KY12501599Medicaid