Provider Demographics
NPI:1376767335
Name:RESIDENTIAL CARE CENTER OF PADUCAH
Entity Type:Organization
Organization Name:RESIDENTIAL CARE CENTER OF PADUCAH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-442-6441
Mailing Address - Street 1:2301 IRVIN COBB DR
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-6447
Mailing Address - Country:US
Mailing Address - Phone:270-442-6441
Mailing Address - Fax:270-442-0283
Practice Address - Street 1:2301 IRVIN COBB DR
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-6447
Practice Address - Country:US
Practice Address - Phone:270-442-6441
Practice Address - Fax:270-442-0283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100626311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home