Provider Demographics
NPI:1760967079
Name:PEMBROKE OPERATING COMPANY LLC
Entity Type:Organization
Organization Name:PEMBROKE OPERATING COMPANY LLC
Other - Org Name:CHRISTIAN HEIGHTS NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MOSHE
Authorized Official - Middle Name:
Authorized Official - Last Name:KELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-475-4227
Mailing Address - Street 1:124 W NASHVILLE ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:KY
Mailing Address - Zip Code:42266-9763
Mailing Address - Country:US
Mailing Address - Phone:270-475-4227
Mailing Address - Fax:270-475-4173
Practice Address - Street 1:124 W NASHVILLE ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:KY
Practice Address - Zip Code:42266-9763
Practice Address - Country:US
Practice Address - Phone:270-475-4227
Practice Address - Fax:270-475-4173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-02
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY100069OtherLICENSE
KY7100579270Medicaid