1518050657 NPI number — N & R OF PIMLICO, LLC

Table of content: (NPI 1518050657)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518050657 NPI number — N & R OF PIMLICO, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
N & R OF PIMLICO, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PIMLICO MANOR
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518050657
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
329 TOWNEPARK CIR
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40243-2348
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-254-9525
Provider Business Mailing Address Fax Number:
502-254-9919

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3576 PIMLICO PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40517-3700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-272-0608
Provider Business Practice Location Address Fax Number:
859-272-1273
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VINSON
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
502-254-9525

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  100492 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 244321 . This is a "KY TAX ID NUMBER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 12504437 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7392681 . This is a "KY UNEMPLOYMENT INSURANCE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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