Provider Demographics
NPI:1952499097
Name:DARBY SQUARE SERVICES,LLC
Entity Type:Organization
Organization Name:DARBY SQUARE SERVICES,LLC
Other - Org Name:HAMBURG HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:TSCHUDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-429-8062
Mailing Address - Street 1:2770 PALUMBO DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1232
Mailing Address - Country:US
Mailing Address - Phone:859-263-2410
Mailing Address - Fax:
Practice Address - Street 1:2770 PALUMBO DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1232
Practice Address - Country:US
Practice Address - Phone:859-263-2410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100572313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY12500922Medicaid
KY42-5251Medicare ID - Type Unspecified