Provider Demographics
NPI:1881620490
Name:SAYRE CHRISTIAN VILLAGE NURSING HOME, INC.
Entity type:Organization
Organization Name:SAYRE CHRISTIAN VILLAGE NURSING HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:M
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-271-9000
Mailing Address - Street 1:3775 BELLEAU WOOD DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-1804
Mailing Address - Country:US
Mailing Address - Phone:859-271-9000
Mailing Address - Fax:859-271-8160
Practice Address - Street 1:3775 BELLEAU WOOD DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-1804
Practice Address - Country:US
Practice Address - Phone:859-271-9000
Practice Address - Fax:859-271-8160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
314000000X
KY100544314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY12501045Medicaid
KY12501045Medicaid