Provider Demographics
NPI:1669590774
Name:BG HOUSE ENTERPRISES INC
Entity type:Organization
Organization Name:BG HOUSE ENTERPRISES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:P
Authorized Official - Last Name:MASKALICK
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:502-477-0300
Mailing Address - Street 1:4813 TAYLORSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40071
Mailing Address - Country:US
Mailing Address - Phone:502-477-0300
Mailing Address - Fax:502-477-0303
Practice Address - Street 1:4813 TAYLORSVILLE RD
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40071
Practice Address - Country:US
Practice Address - Phone:502-477-0300
Practice Address - Fax:502-477-0303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY186589Medicare Oscar/Certification
KY4348860001Medicare NSC