Provider Demographics
NPI:1235128901
Name:NEW GREEN VALLEY HEALTH & REHABILITATION CENTER, LLC
Entity Type:Organization
Organization Name:NEW GREEN VALLEY HEALTH & REHABILITATION CENTER, LLC
Other - Org Name:GREEN VALEEY HEALTH & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-732-6683
Mailing Address - Street 1:1206 11TH ST
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:KY
Mailing Address - Zip Code:41008-9704
Mailing Address - Country:US
Mailing Address - Phone:502-732-6683
Mailing Address - Fax:502-732-0330
Practice Address - Street 1:1206 11TH ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:KY
Practice Address - Zip Code:41008-9704
Practice Address - Country:US
Practice Address - Phone:502-732-6683
Practice Address - Fax:502-732-0330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100494314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY18-5205Medicare ID - Type Unspecified