Provider Demographics
NPI:1740268689
Name:BARDSTOWN ELDERCARE LLC
Entity type:Organization
Organization Name:BARDSTOWN ELDERCARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:FLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-707-1014
Mailing Address - Street 1:101 W STEPHEN FOSTER AVE
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-1470
Mailing Address - Country:US
Mailing Address - Phone:502-707-1014
Mailing Address - Fax:502-348-5500
Practice Address - Street 1:103 ISAAC GREER CT
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-2562
Practice Address - Country:US
Practice Address - Phone:502-349-6214
Practice Address - Fax:502-348-5500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-31
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY101019314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY185457Medicare Oscar/Certification