Provider Demographics
NPI:1457614075
Name:TRILOGY HEALTHCARE OF FAYETTE I, LLC
Entity Type:Organization
Organization Name:TRILOGY HEALTHCARE OF FAYETTE I, LLC
Other - Org Name:THE WILLOWS AT HAMBURG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:PLEVYAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-213-1710
Mailing Address - Street 1:2531 OLD ROSEBUD RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-4574
Mailing Address - Country:US
Mailing Address - Phone:859-543-0337
Mailing Address - Fax:859-543-0338
Practice Address - Street 1:2531 OLD ROSEBUD RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-4574
Practice Address - Country:US
Practice Address - Phone:859-543-0337
Practice Address - Fax:859-543-0338
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRILOGY FSC HOLDINGS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-06-19
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility