Active NPI
Beaver Dam Nursing & Rehab Center, Inc
- Skilled Nursing Facility
- Beaver Dam, KY
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 100353
- Legal business name
- BEAVER DAM NURSING & REHAB CENTER, INC
- Practice address
- 1595 US Highway 231 S
Beaver Dam, KY 42320-9463 - Phone
- (270) 274-9646
- NPI assigned
- Nov 12, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Douglas P Cox
- Title
- President
- Phone
- (615) 478-6181
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 100353 | KY | Primary |
Addresses
Primary practice location
1595 US Highway 231 S
Beaver Dam, KY 42320-9463
Mailing address
1595 US Highway 231 S
Beaver Dam, KY 42320-9463
Phone (270) 274-9646
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7100125280 | Medicaid | KY | |
| 12503595 | Medicaid | KY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in KY
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20060410000258 | KY | Part A Provider - Skilled Nursing Facility | 3173532751 | Practice locations: Beaver Dam, KY |
Skilled nursing facility certification: CCN 185334
- Legal name
- BEAVER DAM NURSING & REHAB CENTER, INC
- Doing business as
- BEAVER DAM NURSING & REHAB CENTER
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jun 1, 1992
- Last certification
- May 8, 2025
- Beds
- 58
- Ownership / control type
- Limited Liability Corporation
- Organization structure
- Corporation
- Incorporated
- Nov 4, 2005 in KY
- Enrollment address
- 1595 S US Highway 231
Beaver Dam, KY 42320-9463 - Nursing home name
- BEAVER DAM NURSING & REHAB CENTER, INC
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Beaver Dam Nursing & Rehab Center, Inc
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Jun 1, 1992
- Medicare certification status
- Active
- Certified beds
- 58
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 18D0712603 | Beaver Dam Nursing & Rehab Center, Inc | Certificate of waiver | Aug 31, 2026 |
National Provider Directory
National Provider DirectoryOwnership & related parties
All disclosed owners & managing parties 2
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Douglas P Cox | 5% Or Greater Direct Ownership Interest | Jan 1, 2023 | 100% |
| 5% Or Greater Mortgage Interest | Jan 1, 2015 | 100% | |
| Corporate Officer | Jan 1, 2015 | ||
| Operational/Managerial Control | Jan 1, 2015 | ||
| Other | Jan 1, 2023 | ||
| Stephen Michael Nee | Corporate Officer | Aug 1, 2019 |
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Family Medicine Physician
- Owensboro, KY
- NPI 1306838693
-
- Family Medicine Physician
- Beaver Dam, KY
- NPI 1457655730
Affiliated clinicians 2
Clinicians who list this facility as an affiliation in Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163289600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1439856000000",
"number": "1669543716",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1595 US HIGHWAY 231 S",
"city": "BEAVER DAM",
"state": "KY",
"postal_code": "423209463",
"telephone_number": "270-274-9646"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1595 US HIGHWAY 231 S",
"city": "BEAVER DAM",
"state": "KY",
"postal_code": "423209463",
"telephone_number": "270-274-9646"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BEAVER DAM NURSING & REHAB CENTER, INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-11-12",
"last_updated": "2015-08-18",
"status": "A",
"authorized_official_last_name": "COX",
"authorized_official_first_name": "DOUGLAS",
"authorized_official_middle_name": "P",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "615-478-6181"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "KY",
"license": "100353",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7100125280",
"state": "KY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "12503595",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Beaver Dam, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.