Provider Demographics
NPI:1518050657
Name:N & R OF PIMLICO, LLC
Entity Type:Organization
Organization Name:N & R OF PIMLICO, LLC
Other - Org Name:PIMLICO MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:VINSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:502-254-9525
Mailing Address - Street 1:329 TOWNEPARK CIR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-2348
Mailing Address - Country:US
Mailing Address - Phone:502-254-9525
Mailing Address - Fax:502-254-9919
Practice Address - Street 1:3576 PIMLICO PKWY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-3700
Practice Address - Country:US
Practice Address - Phone:859-272-0608
Practice Address - Fax:859-272-1273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100492314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY244321OtherKY TAX ID NUMBER
KY12504437Medicaid
KY7392681OtherKY UNEMPLOYMENT INSURANCE
KY7392681OtherKY UNEMPLOYMENT INSURANCE