Creekwood Place Nursing & Rehab Center, Inc.
Organization Active NPI Skilled Nursing Facility · Russellville, KY
NPI 1619982410 · NPPES record last updated Dec 30, 2015
Key facts
- NPI
- 1619982410
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 100299 (KY)
- Legal business name
- CREEKWOOD PLACE NURSING & REHAB CENTER, INC.
- Practice address
- 107 Boyles Dr
Russellville, KY 42276-8838 - Phone
- (270) 726-9049
- Fax
- (270) 726-8706
- NPI assigned
- Jul 30, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. David Rodman
- Title
- Asst Secretary
- Phone
- (407) 975-3011
National Provider Directory
Locations
683 E 3rd St
Russellville, KY 42276
Phone (270) 726-9049
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 100299 | KY | Yes |
| Durable Medical Equipment & Medical Supplies | 332B00000X | 90003948 | KY |
Addresses
Primary practice location
107 Boyles Dr
Russellville, KY 42276-8838
Mailing address
485 N Keller Rd
Suite 250
Maitland, FL 32751-7503
Phone (407) 975-3000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7100025410 | Medicaid | KY | |
| 90003948 | Medicaid | KY |
Other providers in Russellville, KY
- Community Health Centers of Western Kentucky Inc
- Kristen Rebecca Cooper
- Melissa D Corbin
- Rebecca Sue Coursey
- Terry A. Crafton
- Creekwood Place Opco LLC
- Cumberland Plastic Surgery PLLC
- Darla Sherrod Barrow
- David R. Whitley
- Erin Deans
All providers in Russellville, KY · Skilled Nursing Facility in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 30, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.