Provider Demographics
NPI:1356467666
Name:BENNETTS PERSONAL CARE LLC
Entity Type:Organization
Organization Name:BENNETTS PERSONAL CARE LLC
Other - Org Name:BENNETTS PERSONAL CARE HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:H
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-654-4663
Mailing Address - Street 1:PO BOX 209
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:KY
Mailing Address - Zip Code:41040-0209
Mailing Address - Country:US
Mailing Address - Phone:859-654-4663
Mailing Address - Fax:859-654-1765
Practice Address - Street 1:307 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:KY
Practice Address - Zip Code:41040-1113
Practice Address - Country:US
Practice Address - Phone:859-654-4663
Practice Address - Fax:859-654-1765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100363310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY100363Medicaid