Provider Demographics
NPI:1851379788
Name:BRYAN S. MCCOY, INC.
Entity Type:Organization
Organization Name:BRYAN S. MCCOY, INC.
Other - Org Name:TWINBROOK NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSING HOME ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADFORD
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-452-6331
Mailing Address - Street 1:3526 DUTCHMANS LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-3256
Mailing Address - Country:US
Mailing Address - Phone:502-452-6331
Mailing Address - Fax:
Practice Address - Street 1:3526 DUTCHMANS LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-3256
Practice Address - Country:US
Practice Address - Phone:502-452-6331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY12504734Medicaid
KY5400944400Medicaid
KY5400944400Medicaid