Provider Demographics
NPI:1609040617
Name:NRA BARBOURVILLE HOME THERAPY CENTER KENTUCKY LLC
Entity Type:Organization
Organization Name:NRA BARBOURVILLE HOME THERAPY CENTER KENTUCKY LLC
Other - Org Name:BARBOURVILLE HOME DIALYSIS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:FAWCETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-9000
Mailing Address - Street 1:315 HOSPITAL DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BARBOURVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40906-7917
Mailing Address - Country:US
Mailing Address - Phone:606-545-6600
Mailing Address - Fax:606-546-2964
Practice Address - Street 1:315 HOSPITAL DR
Practice Address - Street 2:SUITE 3
Practice Address - City:BARBOURVILLE
Practice Address - State:KY
Practice Address - Zip Code:40906-7917
Practice Address - Country:US
Practice Address - Phone:606-545-6600
Practice Address - Fax:606-546-2964
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-22
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY182593Medicare Oscar/Certification