Provider Demographics
NPI:1528872579
Name:LANDING OF LONG COVE, LLC
Entity type:Organization
Organization Name:LANDING OF LONG COVE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:CULLITON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-777-1127
Mailing Address - Street 1:130 SAINT MATTHEWS AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-3142
Mailing Address - Country:US
Mailing Address - Phone:502-777-1127
Mailing Address - Fax:
Practice Address - Street 1:5535 IRWIN SIMPSON RD
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-8107
Practice Address - Country:US
Practice Address - Phone:513-229-3155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-01
Last Update Date:2025-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility