Provider Demographics
NPI:1104664705
Name:MONTICELLO KY OPCO LLC
Entity type:Organization
Organization Name:MONTICELLO KY OPCO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:COGAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-667-8150
Mailing Address - Street 1:1901 KY-90
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:KY
Mailing Address - Zip Code:42633
Mailing Address - Country:US
Mailing Address - Phone:502-667-8150
Mailing Address - Fax:502-467-8720
Practice Address - Street 1:1901 KY-90
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:KY
Practice Address - Zip Code:42633
Practice Address - Country:US
Practice Address - Phone:606-348-6034
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility