Provider Demographics
NPI:1194786632
Name:BAPTIST CONVALESCENT CENTER, INC.
Entity type:Organization
Organization Name:BAPTIST CONVALESCENT CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:859-491-3800
Mailing Address - Street 1:800 HIGHLAND AVE
Mailing Address - Street 2:SUITE 30
Mailing Address - City:FT WRIGHT
Mailing Address - State:KY
Mailing Address - Zip Code:41011-4001
Mailing Address - Country:US
Mailing Address - Phone:859-547-3353
Mailing Address - Fax:859-547-3344
Practice Address - Street 1:800 HIGHLAND AVE
Practice Address - Street 2:SUITE 30
Practice Address - City:FT WRIGHT
Practice Address - State:KY
Practice Address - Zip Code:41011-4001
Practice Address - Country:US
Practice Address - Phone:859-547-3353
Practice Address - Fax:859-547-3344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY150180251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY34000075Medicaid
187173Medicare ID - Type Unspecified