Provider Demographics
NPI:1144346412
Name:NORTHERN KENTUCKY LIVING CENTERS LLC.
Entity type:Organization
Organization Name:NORTHERN KENTUCKY LIVING CENTERS LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:HEATH
Authorized Official - Middle Name:R
Authorized Official - Last Name:CULBERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-954-1494
Mailing Address - Street 1:P.O. BOX 83
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:KY
Mailing Address - Zip Code:41040
Mailing Address - Country:US
Mailing Address - Phone:859-954-1494
Mailing Address - Fax:859-654-1765
Practice Address - Street 1:208 MEMORY DRIVE
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:KY
Practice Address - Zip Code:41040
Practice Address - Country:US
Practice Address - Phone:859-654-8900
Practice Address - Fax:859-654-1765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY750108261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100199920Medicaid
KY43000090Medicaid