Provider Demographics
NPI:1487781183
Name:MCKENZIE HEALTH CARE, LLC
Entity type:Organization
Organization Name:MCKENZIE HEALTH CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:MCKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-638-4586
Mailing Address - Street 1:270 EAST CLAYTON LANE
Mailing Address - Street 2:
Mailing Address - City:LOUISA
Mailing Address - State:KY
Mailing Address - Zip Code:41230-8622
Mailing Address - Country:US
Mailing Address - Phone:606-638-4586
Mailing Address - Fax:606-638-0367
Practice Address - Street 1:270 E CLAYTON LN
Practice Address - Street 2:
Practice Address - City:LOUISA
Practice Address - State:KY
Practice Address - Zip Code:41230-8622
Practice Address - Country:US
Practice Address - Phone:606-638-4586
Practice Address - Fax:606-638-0367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY43000173261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY43000173Medicaid