Provider Demographics
NPI:1609961820
Name:MOUNT WASHINGTON HEALTH CARE LLC
Entity Type:Organization
Organization Name:MOUNT WASHINGTON HEALTH CARE LLC
Other - Org Name:GREEN MEADOWS HEALTH CARE CENTER I
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRES
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:T
Authorized Official - Last Name:SLEADD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-254-5464
Mailing Address - Street 1:310 BOXWOOD RUN RD
Mailing Address - Street 2:
Mailing Address - City:MT WASHINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40047-7143
Mailing Address - Country:US
Mailing Address - Phone:520-538-3500
Mailing Address - Fax:502-955-7395
Practice Address - Street 1:310 BOXWOOD RUN
Practice Address - Street 2:
Practice Address - City:MT WASHINGTON
Practice Address - State:KY
Practice Address - Zip Code:40047-7143
Practice Address - Country:US
Practice Address - Phone:520-538-3500
Practice Address - Fax:502-955-7395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY12505152Medicaid
KY185464Medicare Oscar/Certification
KY12505152Medicaid