Provider Demographics
NPI:1114918364
Name:BOLSTER & JEFFRIES HEALTH CARE GROUP LLC
Entity Type:Organization
Organization Name:BOLSTER & JEFFRIES HEALTH CARE GROUP LLC
Other - Org Name:HEARTHSTONE PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-265-5321
Mailing Address - Street 1:PO BOX 427
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:KY
Mailing Address - Zip Code:42220-0427
Mailing Address - Country:US
Mailing Address - Phone:270-265-5321
Mailing Address - Fax:270-265-3126
Practice Address - Street 1:506 ALLENSVILLE ST
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:KY
Practice Address - Zip Code:42220-8834
Practice Address - Country:US
Practice Address - Phone:270-265-5321
Practice Address - Fax:270-265-3126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-04
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100395314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY12504288Medicaid
KY90005877Medicaid
4429540001Medicare NSC
KY90005877Medicaid