Provider Demographics
NPI:1386630028
Name:LORETTO MOTHERHOUSE
Entity type:Organization
Organization Name:LORETTO MOTHERHOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ESSEX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-856-5811
Mailing Address - Street 1:515 NERINX RD
Mailing Address - Street 2:
Mailing Address - City:NERINX
Mailing Address - State:KY
Mailing Address - Zip Code:40049-9998
Mailing Address - Country:US
Mailing Address - Phone:270-865-5811
Mailing Address - Fax:270-865-5013
Practice Address - Street 1:515 NERINX RD
Practice Address - Street 2:
Practice Address - City:NERINX
Practice Address - State:KY
Practice Address - Zip Code:40049-9998
Practice Address - Country:US
Practice Address - Phone:270-865-5811
Practice Address - Fax:270-865-5013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY314000000X314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000054559OtherBC/BS OF KENTUCKY
KY12501839Medicaid
KY000000054559OtherBC/BS OF KENTUCKY