Provider Demographics
NPI:1164403564
Name:BOLSTER HEALTH CARE GROUP LLC
Entity Type:Organization
Organization Name:BOLSTER HEALTH CARE GROUP LLC
Other - Org Name:AUBURN HEALTH CARE
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:OWNER
Authorized Official - Phone:270-265-5321
Mailing Address - Street 1:139 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:KY
Mailing Address - Zip Code:42206-5121
Mailing Address - Country:US
Mailing Address - Phone:270-542-4111
Mailing Address - Fax:270-542-7026
Practice Address - Street 1:139 PEARL ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:KY
Practice Address - Zip Code:42206-5121
Practice Address - Country:US
Practice Address - Phone:270-542-4111
Practice Address - Fax:270-542-7026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-11
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100295314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90005885Medicaid
KY12504296Medicaid
KY12504296Medicaid
185049Medicare ID - Type Unspecified