Provider Demographics
NPI:1164422945
Name:BUTLER REST HOME, INC
Entity Type:Organization
Organization Name:BUTLER REST HOME, INC
Other - Org Name:RIVER VALLEY NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:URLAGE
Authorized Official - Suffix:
Authorized Official - Credentials:BS BUSINESS ADMINI
Authorized Official - Phone:859-472-2217
Mailing Address - Street 1:PO BOX 402
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:KY
Mailing Address - Zip Code:41006-0402
Mailing Address - Country:US
Mailing Address - Phone:859-472-2217
Mailing Address - Fax:859-472-5869
Practice Address - Street 1:305 TAYLOR LN
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:KY
Practice Address - Zip Code:41006-8550
Practice Address - Country:US
Practice Address - Phone:859-472-2217
Practice Address - Fax:859-472-5869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-22
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100362314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1207260001OtherDEMARC
KY12501540Medicaid
KY1207260001OtherDEMARC