Provider Demographics
NPI:1700183027
Name:CAMBRIDGE PLACE GROUP, LLC
Entity Type:Organization
Organization Name:CAMBRIDGE PLACE GROUP, LLC
Other - Org Name:CAMBRIDGE PLACE
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-588-4302
Mailing Address - Street 1:2020 CAMBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-1912
Mailing Address - Country:US
Mailing Address - Phone:859-252-6747
Mailing Address - Fax:859-255-9914
Practice Address - Street 1:2020 CAMBRIDGE DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-1912
Practice Address - Country:US
Practice Address - Phone:859-252-6747
Practice Address - Fax:859-255-9914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-23
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100461314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100180620Medicaid
KY185444Medicare Oscar/Certification