Provider Demographics
NPI:1851338784
Name:HURSTBOURNE HEALTHCARE LLC
Entity Type:Organization
Organization Name:HURSTBOURNE HEALTHCARE LLC
Other - Org Name:HURSTBOURNE CARE CENTRE AT STONY BROOK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:T
Authorized Official - Last Name:BABER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-495-6240
Mailing Address - Street 1:2200 STONY BROOK DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-4016
Mailing Address - Country:US
Mailing Address - Phone:502-495-6240
Mailing Address - Fax:502-495-0324
Practice Address - Street 1:2200 STONY BROOK DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-4016
Practice Address - Country:US
Practice Address - Phone:502-495-6240
Practice Address - Fax:502-495-0324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100645 NF314000000X
KY100645 PCH314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY12504692Medicaid
KY12504692Medicaid
185289Medicare Oscar/Certification