Provider Demographics
NPI:1649261314
Name:THIRD AND OAK CORPORATION
Entity type:Organization
Organization Name:THIRD AND OAK CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:CIEMINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:502-589-3211
Mailing Address - Street 1:211 WEST OAK STREET
Mailing Address - Street 2:TREYTON OAK TOWERS
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40203
Mailing Address - Country:US
Mailing Address - Phone:502-589-3211
Mailing Address - Fax:502-589-7263
Practice Address - Street 1:211 WEST OAK STREET
Practice Address - Street 2:TREYTON OAK TOWERS
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40203
Practice Address - Country:US
Practice Address - Phone:502-589-3211
Practice Address - Fax:502-589-7263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-02
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100548314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY12502290Medicaid
KY12502290Medicaid