Provider Demographics
NPI:1932684230
Name:HENDERSON OPCO LLC
Entity Type:Organization
Organization Name:HENDERSON OPCO LLC
Other - Org Name:HENDERSON NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MOSHE
Authorized Official - Middle Name:
Authorized Official - Last Name:KELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-826-9794
Mailing Address - Street 1:2500 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-2005
Mailing Address - Country:US
Mailing Address - Phone:270-826-9794
Mailing Address - Fax:270-826-6265
Practice Address - Street 1:2500 N ELM ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-2005
Practice Address - Country:US
Practice Address - Phone:270-826-9794
Practice Address - Fax:270-826-6265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-02
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY100175OtherLICENSE
KY7100579320Medicaid