Provider Demographics
NPI:1831144112
Name:FS LEXINGTON TENANT TRUST
Entity Type:Organization
Organization Name:FS LEXINGTON TENANT TRUST
Other - Org Name:LEXINGTON COUNTRY PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-796-8387
Mailing Address - Street 1:700 MASON HEADLEY ROAD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-2326
Mailing Address - Country:US
Mailing Address - Phone:859-259-3486
Mailing Address - Fax:859-276-2751
Practice Address - Street 1:700 MASON HEADLEY ROAD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-2326
Practice Address - Country:US
Practice Address - Phone:859-259-3486
Practice Address - Fax:859-276-2751
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FS LEXINGTON TENANT TRUST
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-24
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100527314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY12504262Medicaid
KY185160Medicare Oscar/Certification