Provider Demographics
NPI:1578163697
Name:PROVIDENCE POINT HEALTHCARE, INC.
Entity Type:Organization
Organization Name:PROVIDENCE POINT HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND COO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:NEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-247-3202
Mailing Address - Street 1:100 MARSHALL CT
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-9639
Mailing Address - Country:US
Mailing Address - Phone:270-442-6884
Mailing Address - Fax:
Practice Address - Street 1:100 MARSHALL CT
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-9639
Practice Address - Country:US
Practice Address - Phone:270-442-6884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility