Provider Demographics
NPI:1245229046
Name:NEW MEADOWVIEW HEALTH & REHABILITATION CENTER, LLC
Entity Type:Organization
Organization Name:NEW MEADOWVIEW HEALTH & REHABILITATION CENTER, LLC
Other - Org Name:MEADOWVIEW HEALTH & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:UPTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-426-2778
Mailing Address - Street 1:9701 WHIPPS MILL RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-1103
Mailing Address - Country:US
Mailing Address - Phone:502-426-2778
Mailing Address - Fax:502-426-7211
Practice Address - Street 1:9701 WHIPPS MILL RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-1103
Practice Address - Country:US
Practice Address - Phone:502-426-2778
Practice Address - Fax:502-426-7211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-14
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100226314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY18-5278Medicare ID - Type Unspecified