Provider Demographics
NPI:1982701413
Name:THAMES HEALTHCARE GROUP, LLC
Entity Type:Organization
Organization Name:THAMES HEALTHCARE GROUP, LLC
Other - Org Name:JOHNSON MATHERS NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:G
Authorized Official - Last Name:MCDANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-523-9094
Mailing Address - Street 1:2323 CONCRETE RD
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:KY
Mailing Address - Zip Code:40311-9721
Mailing Address - Country:US
Mailing Address - Phone:859-289-3492
Mailing Address - Fax:859-289-3493
Practice Address - Street 1:2323 CONCRETE RD
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:KY
Practice Address - Zip Code:40311-9721
Practice Address - Country:US
Practice Address - Phone:859-289-3492
Practice Address - Fax:859-289-3493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-19
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100349314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY12500906Medicaid
KY7100199360Medicaid
KY185028Medicare PIN