Provider Demographics
NPI:1285852954
Name:ROLLINS BEDFORD CORPORATION
Entity Type:Organization
Organization Name:ROLLINS BEDFORD CORPORATION
Other - Org Name:LEITCHFIELD HEALTH CARE MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:M
Authorized Official - Last Name:WEHTJE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-975-3010
Mailing Address - Street 1:602 COURTLAND ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-1360
Mailing Address - Country:US
Mailing Address - Phone:407-975-3000
Mailing Address - Fax:407-975-3090
Practice Address - Street 1:718 GOODWIN LN
Practice Address - Street 2:
Practice Address - City:LEITCHFIELD
Practice Address - State:KY
Practice Address - Zip Code:42754-1400
Practice Address - Country:US
Practice Address - Phone:270-259-4036
Practice Address - Fax:270-259-3205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100149314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90003930Medicaid
KY12504114Medicaid
KY90003930Medicaid
KY185309Medicare Oscar/Certification