Provider Demographics
NPI:1295773786
Name:BROWNSBORO HILLS HEALTHCARE LLC
Entity type:Organization
Organization Name:BROWNSBORO HILLS HEALTHCARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:RAWLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-895-5417
Mailing Address - Street 1:2141 SYCAMORE AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-2013
Mailing Address - Country:US
Mailing Address - Phone:502-895-5417
Mailing Address - Fax:502-895-3706
Practice Address - Street 1:2141 SYCAMORE AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-2013
Practice Address - Country:US
Practice Address - Phone:502-895-5417
Practice Address - Fax:502-895-3706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100197 NH314000000X
KY100197 NF314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY12504700Medicaid
185348Medicare Oscar/Certification