Provider Demographics
NPI:1821087735
Name:NEW HERITAGE HALL HEALTH & REHABILITATION CENTER, LLC
Entity Type:Organization
Organization Name:NEW HERITAGE HALL HEALTH & REHABILITATION CENTER, LLC
Other - Org Name:HERITAGE HALL HEALTH & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-839-7246
Mailing Address - Street 1:331 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40342-1215
Mailing Address - Country:US
Mailing Address - Phone:502-839-7246
Mailing Address - Fax:502-839-0744
Practice Address - Street 1:331 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:KY
Practice Address - Zip Code:40342-1215
Practice Address - Country:US
Practice Address - Phone:502-839-7246
Practice Address - Fax:502-839-0744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100431314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY18-5277Medicare ID - Type Unspecified