Provider Demographics
NPI:1619303013
Name:TRILOGY HEALTHCARE OF FAYETTE III, LLC
Entity Type:Organization
Organization Name:TRILOGY HEALTHCARE OF FAYETTE III, LLC
Other - Org Name:THE WILLOWS AT CITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP FINANCE & OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:P
Authorized Official - Last Name:PLEVYAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-412-5847
Mailing Address - Street 1:1376 SILVER SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40511-2319
Mailing Address - Country:US
Mailing Address - Phone:859-277-0320
Mailing Address - Fax:
Practice Address - Street 1:1376 SILVER SPRINGS DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40511-2319
Practice Address - Country:US
Practice Address - Phone:859-277-0320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRILOGY FSC INVESTORS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-09-18
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
185474Medicare Oscar/Certification