Provider Demographics
NPI:1568790665
Name:FERN TERRACE OF OWENSBORO, LLC
Entity Type:Organization
Organization Name:FERN TERRACE OF OWENSBORO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:270-683-5571
Mailing Address - Street 1:7 WOODFORD AVE
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-0563
Mailing Address - Country:US
Mailing Address - Phone:270-683-5571
Mailing Address - Fax:
Practice Address - Street 1:45 WOODFORD AVE
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-0563
Practice Address - Country:US
Practice Address - Phone:270-684-7171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAVCO HOMES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-12-01
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100096310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility