Jackson Manor LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

JACKSON MANOR LLC

Practice address

96 Highway 3444
Annville, KY 40402-8245

Phone

(502) 714-7444

NPI assigned

Apr 15, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Robin Barber

Title

Executive Vice President

Phone

(502) 714-7444

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Annville Adult Day Healthcare Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• New Jackson Manor, LLC

  • Adult Day Care Clinic/Center
  • Annville, KY
  • NPI 1407845639
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1460678400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1460678400000",
    "number": "1902250012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 N HURSTBOURNE PKWY",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402225393",
            "telephone_number": "502-714-7444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "96 HIGHWAY 3444",
            "city": "ANNVILLE",
            "state": "KY",
            "postal_code": "404028245",
            "telephone_number": "502-714-7444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON MANOR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-15",
        "last_updated": "2016-04-15",
        "status": "A",
        "authorized_official_last_name": "BARBER",
        "authorized_official_first_name": "ROBIN",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT",
        "authorized_official_telephone_number": "502-714-7444",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "12504965",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Candie Naomi Dalton, PT
• Dove Medical Equipment, Inc
• East Bernstadt Medical Clinic PLLC
• Tara England, MA, CCC/SLP
• Family Health Care Associates 2
• Keith Lakes, LPCC
• LP Annville, LLC
• New Jackson Manor, LLC
• New Jackson Manor, LLC
• Camille Brooke Saunders, LCSW

• All providers in Annville, KY
• Skilled Nursing Facility in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.