Provider Demographics
NPI:1912493149
Name:TRILOGY HEALTHCARE OF JEFFERSON II, LLC
Entity Type:Organization
Organization Name:TRILOGY HEALTHCARE OF JEFFERSON II, LLC
Other - Org Name:THE SPRINGS AT STONY BROOK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT AND TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-213-1893
Mailing Address - Street 1:303 N HURSTBOURNE PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-5158
Mailing Address - Country:US
Mailing Address - Phone:502-412-5847
Mailing Address - Fax:502-412-0407
Practice Address - Street 1:2200 STONY BROOK DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-4016
Practice Address - Country:US
Practice Address - Phone:502-491-4692
Practice Address - Fax:502-491-4693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100645314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility