Provider Demographics
NPI:1346361193
Name:LETCHER COUNTY GOLDEN YEARS REST HOME
Entity type:Organization
Organization Name:LETCHER COUNTY GOLDEN YEARS REST HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:F
Authorized Official - Last Name:T ACKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-832-2123
Mailing Address - Street 1:PO BOX 867
Mailing Address - Street 2:
Mailing Address - City:JENKINS
Mailing Address - State:KY
Mailing Address - Zip Code:41537
Mailing Address - Country:US
Mailing Address - Phone:606-832-2123
Mailing Address - Fax:606-832-4893
Practice Address - Street 1:53 WHEATON HOLLOW ROAD
Practice Address - Street 2:
Practice Address - City:JENKINS
Practice Address - State:KY
Practice Address - Zip Code:41537
Practice Address - Country:US
Practice Address - Phone:606-832-2123
Practice Address - Fax:606-832-4893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100287313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility