Provider Demographics
NPI:1750493151
Name:WILLIAMSBURG NURSING HOME, INC.
Entity Type:Organization
Organization Name:WILLIAMSBURG NURSING HOME, INC.
Other - Org Name:WILLIAMSBURG NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:EMANUEL
Authorized Official - Last Name:FORCHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-528-9600
Mailing Address - Street 1:PO BOX 719
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40769-0719
Mailing Address - Country:US
Mailing Address - Phone:606-549-4321
Mailing Address - Fax:606-549-4324
Practice Address - Street 1:287 N 11TH ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:KY
Practice Address - Zip Code:40769-1759
Practice Address - Country:US
Practice Address - Phone:606-549-4321
Practice Address - Fax:606-549-4324
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIRST CORBIN LONG TERM CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-31
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100488314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY12500344Medicaid
KY000000054731OtherANTHEM BCBS
KY185148Medicare Oscar/Certification