Provider Demographics
NPI:1467171892
Name:SKC1010 LLC
Entity Type:Organization
Organization Name:SKC1010 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:
Authorized Official - First Name:STACI
Authorized Official - Middle Name:KATHERINE
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:270-566-1274
Mailing Address - Street 1:170 COLSON DR
Mailing Address - Street 2:
Mailing Address - City:RUSSELL SPRINGS
Mailing Address - State:KY
Mailing Address - Zip Code:42642-4587
Mailing Address - Country:US
Mailing Address - Phone:270-566-1274
Mailing Address - Fax:
Practice Address - Street 1:170 COLSON DR
Practice Address - Street 2:
Practice Address - City:RUSSELL SPRINGS
Practice Address - State:KY
Practice Address - Zip Code:42642-4587
Practice Address - Country:US
Practice Address - Phone:270-566-1274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care