Provider Demographics
NPI:1356848147
Name:CONUNDRUM, INC
Entity Type:Organization
Organization Name:CONUNDRUM, INC
Other - Org Name:AMADA SENIOR CARE OF GREATER LEXINGTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:859-963-1842
Mailing Address - Street 1:107 FRAZIER CT STE 2B
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-8973
Mailing Address - Country:US
Mailing Address - Phone:859-963-1842
Mailing Address - Fax:859-757-4833
Practice Address - Street 1:107 FRAZIER CT STE 2B
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324
Practice Address - Country:US
Practice Address - Phone:859-963-1842
Practice Address - Fax:859-757-4833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-09
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY500290251E00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY=========OtherPRIVATE PAY OR VA BENEFITS OR LONG TERM CARE INSURANCE