Provider Demographics
NPI:1467937748
Name:BRANDENBURG OPCO LLC
Entity Type:Organization
Organization Name:BRANDENBURG OPCO LLC
Other - Org Name:BRANDENBURG NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MOSHE
Authorized Official - Middle Name:
Authorized Official - Last Name:KELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-422-2148
Mailing Address - Street 1:814 OLD EKRON RD
Mailing Address - Street 2:
Mailing Address - City:BRANDENBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40108-1149
Mailing Address - Country:US
Mailing Address - Phone:270-422-2148
Mailing Address - Fax:270-422-4791
Practice Address - Street 1:814 OLD EKRON RD
Practice Address - Street 2:
Practice Address - City:BRANDENBURG
Practice Address - State:KY
Practice Address - Zip Code:40108-1149
Practice Address - Country:US
Practice Address - Phone:270-422-2148
Practice Address - Fax:270-422-4791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-02
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY100334OtherLICENSE
KY7100578260Medicaid