Provider Demographics
NPI:1770681496
Name:ASHLAND NURSING HOME CORPORATION
Entity Type:Organization
Organization Name:ASHLAND NURSING HOME CORPORATION
Other - Org Name:KINGSBROOK LIFECARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:BRAINARD
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSHA
Authorized Official - Phone:606-324-1414
Mailing Address - Street 1:2500 ST RT 5
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41102
Mailing Address - Country:US
Mailing Address - Phone:606-324-1414
Mailing Address - Fax:606-324-3420
Practice Address - Street 1:2500 ST RT 5
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41102
Practice Address - Country:US
Practice Address - Phone:606-324-1414
Practice Address - Fax:606-324-3420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100029313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY12504304Medicaid
000000246141OtherANTHEM BLUE CROSS
KY12504304Medicaid