Provider Demographics
NPI:1336298470
Name:BAPTIST CONVALESCENT CENTER, INC.
Entity Type:Organization
Organization Name:BAPTIST CONVALESCENT CENTER, INC.
Other - Org Name:BAPTIST CONVALESCENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-283-8600
Mailing Address - Street 1:PO BOX 176188
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41017-6188
Mailing Address - Country:US
Mailing Address - Phone:859-491-3800
Mailing Address - Fax:859-547-3347
Practice Address - Street 1:7341 E ALEXANDRIA PIKE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:KY
Practice Address - Zip Code:41001-1037
Practice Address - Country:US
Practice Address - Phone:859-694-4450
Practice Address - Fax:859-908-0428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY12500088Medicaid
KY185058Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER