Provider Demographics
NPI:1518954486
Name:CARMEL MANOR INC.
Entity Type:Organization
Organization Name:CARMEL MANOR INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-781-5111
Mailing Address - Street 1:100 CARMEL MANOR ROAD
Mailing Address - Street 2:
Mailing Address - City:FT. THOMAS
Mailing Address - State:KY
Mailing Address - Zip Code:41075-2395
Mailing Address - Country:US
Mailing Address - Phone:859-781-5111
Mailing Address - Fax:859-781-2337
Practice Address - Street 1:100 CARMEL MANOR ROAD
Practice Address - Street 2:
Practice Address - City:FT. THOMAS
Practice Address - State:KY
Practice Address - Zip Code:41075-2395
Practice Address - Country:US
Practice Address - Phone:859-781-5111
Practice Address - Fax:859-781-2337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100056251J00000X, 311Z00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY12502332Medicaid
KY12502332Medicaid