Provider Demographics
NPI:1508831033
Name:RBRC, INC.
Entity type:Organization
Organization Name:RBRC, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:T
Authorized Official - Last Name:BEAVEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-822-4218
Mailing Address - Street 1:PO BOX 127
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42461-0127
Mailing Address - Country:US
Mailing Address - Phone:270-822-4218
Mailing Address - Fax:270-822-4210
Practice Address - Street 1:300 BEECH ST
Practice Address - Street 2:
Practice Address - City:KUTTAWA
Practice Address - State:KY
Practice Address - Zip Code:42055-6214
Practice Address - Country:US
Practice Address - Phone:270-388-2868
Practice Address - Fax:270-388-2945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-20
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20010207201310400000X
KY750050311Z00000X
KY100686332BP3500X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY12503652Medicaid
KY43020726Medicaid
KY1233760001OtherPART B SUPPLIER NUMBER
KY1233760001OtherPART B SUPPLIER NUMBER