Provider Demographics
NPI:1700960820
Name:MCKENZIE HEALTH CARE, LLC
Entity Type:Organization
Organization Name:MCKENZIE HEALTH CARE, LLC
Other - Org Name:THE JORDAN CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:MCKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-638-4586
Mailing Address - Street 1:270 E CLAYTON LN
Mailing Address - Street 2:
Mailing Address - City:LOUISA
Mailing Address - State:KY
Mailing Address - Zip Code:41230-8622
Mailing Address - Country:US
Mailing Address - Phone:606-638-4586
Mailing Address - Fax:606-638-0367
Practice Address - Street 1:270 E CLAYTON LN
Practice Address - Street 2:
Practice Address - City:LOUISA
Practice Address - State:KY
Practice Address - Zip Code:41230-8622
Practice Address - Country:US
Practice Address - Phone:606-638-4586
Practice Address - Fax:606-638-0367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY12502076Medicaid
KY12502076Medicaid