Provider Demographics
NPI:1750507547
Name:LEWIS MEMORIAL, INC
Entity Type:Organization
Organization Name:LEWIS MEMORIAL, INC
Other - Org Name:LEWIS MEMORIAL METHODIST HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR, EX-DIR BOARD OF DIR.
Authorized Official - Prefix:MS
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:C
Authorized Official - Last Name:CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-586-3461
Mailing Address - Street 1:2905 BOWLING GREEN RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:KY
Mailing Address - Zip Code:42134-9607
Mailing Address - Country:US
Mailing Address - Phone:270-586-3461
Mailing Address - Fax:270-586-8915
Practice Address - Street 1:2905 BOWLING GREEN RD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:KY
Practice Address - Zip Code:42134-9607
Practice Address - Country:US
Practice Address - Phone:270-586-3461
Practice Address - Fax:270-586-8915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100390311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility