Provider Demographics
NPI:1336136290
Name:BRECKINRIDGE HEALTH, INC.
Entity Type:Organization
Organization Name:BRECKINRIDGE HEALTH, INC.
Other - Org Name:BRECKINRIDGE MEM. NURSING FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSING FACILITY ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:270-756-6577
Mailing Address - Street 1:1011 OLD HIGHWAY 60
Mailing Address - Street 2:
Mailing Address - City:HARDINSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40143-2519
Mailing Address - Country:US
Mailing Address - Phone:270-756-7000
Mailing Address - Fax:270-756-6510
Practice Address - Street 1:1011 OLD HIGHWAY 60
Practice Address - Street 2:
Practice Address - City:HARDINSBURG
Practice Address - State:KY
Practice Address - Zip Code:40143-2519
Practice Address - Country:US
Practice Address - Phone:270-756-7000
Practice Address - Fax:270-756-6510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100738314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000054572OtherBLUE CROSS N F
KY12503173Medicaid
KY185285Medicare Oscar/Certification