Organization Active NPI

Beaver Dam Nursing & Rehab Center, Inc

  • Skilled Nursing Facility
  • Beaver Dam, KY
National Provider Identifier
1669543716
Registry record updated Aug 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
100353 Issued in KY
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

Updated by the provider on Aug 18, 2015

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)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
7100125280MedicaidKY
12503595MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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
CorporationProprietary
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, IncCCN 185334
Overall star rating
3 of 5
Health inspections
3 of 5
Staffing
4 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jun 1, 1992
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
5852.8 residents per day on average

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
18D0712603Beaver Dam Nursing & Rehab Center, Inc1595 US Hwy 231 South, Beaver Dam, KY 42320Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Ownership & 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.

NameRoleSinceShare
Douglas P Cox Individual 5% Or Greater Direct Ownership Interest Jan 1, 2023 100%
5% Or Greater Mortgage Interest Jan 1, 2015 100%
Corporate OfficerChief Executive Officer Jan 1, 2015
Operational/Managerial ControlChief Executive Officer Jan 1, 2015
Other Jan 1, 2023
Stephen Michael Nee Individual Corporate OfficerChief Operating 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.

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

Verify at the official NPI Registry.