Provider Demographics
NPI:1558627281
Name:PAINTSVILLE INVESTORS, LLC
Entity Type:Organization
Organization Name:PAINTSVILLE INVESTORS, LLC
Other - Org Name:MOUNTAIN MANOR OF PAINTSVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:REGENEA
Authorized Official - Last Name:JONES-GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:606-789-5808
Mailing Address - Street 1:1025 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:PAINTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41240-8645
Mailing Address - Country:US
Mailing Address - Phone:606-789-5808
Mailing Address - Fax:606-789-1813
Practice Address - Street 1:1025 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:PAINTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41240-8645
Practice Address - Country:US
Practice Address - Phone:606-789-5808
Practice Address - Fax:606-789-1813
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PAINTSVILLE INVESTORS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-06
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY101129261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)