Provider Demographics
NPI:1326146200
Name:MARLIN K. SPARKS MANAGEMENT COMPANY INC
Entity Type:Organization
Organization Name:MARLIN K. SPARKS MANAGEMENT COMPANY INC
Other - Org Name:CHARLESTON HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:SPARKS
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-236-9292
Mailing Address - Street 1:203 BRUCE CT
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-1948
Mailing Address - Country:US
Mailing Address - Phone:859-236-9292
Mailing Address - Fax:859-236-3713
Practice Address - Street 1:203 BRUCE CT
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-1948
Practice Address - Country:US
Practice Address - Phone:859-236-9292
Practice Address - Fax:859-236-3713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100037313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000054882OtherANTHEM
KY12502480Medicaid
KY12502480Medicaid