Provider Demographics
NPI:1851331672
Name:TRADEWATER POINTE, LLC
Entity Type:Organization
Organization Name:TRADEWATER POINTE, LLC
Other - Org Name:TRADEWATER POINTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANCES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-886-5441
Mailing Address - Street 1:100 W RAMSEY ST
Mailing Address - Street 2:
Mailing Address - City:DAWSON SPRINGS
Mailing Address - State:KY
Mailing Address - Zip Code:42408-1739
Mailing Address - Country:US
Mailing Address - Phone:270-797-8131
Mailing Address - Fax:270-797-3428
Practice Address - Street 1:100 W RAMSEY ST
Practice Address - Street 2:
Practice Address - City:DAWSON SPRINGS
Practice Address - State:KY
Practice Address - Zip Code:42408-1739
Practice Address - Country:US
Practice Address - Phone:270-797-8131
Practice Address - Fax:270-797-3428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100436314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY12504643Medicaid
KY185133Medicare ID - Type Unspecified