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Organization
HBR CAMPBELL LANE, LLC
Active
Organization
HBR CAMPBELL LANE, LLC
Active
Parent organization
HBR KENTUCKY LLC
Other names
Magnolia Village
Organization subpart
Yes
Provider details
NPI number
Legal business name
HBR KENTUCKY LLC
Authorized official
MICHAEL T BERG (ASSISTANT SECRETARY)
(505) 821-3355
Entity
Organization
Contact information
Practice address
1381 CAMPBELL LN, BOWLING GREEN, KY 42104-1049
(270) 843-0587
(270) 843-0874
Mailing address
101 SUN AVE NE, COMPLIANCE DEPARTMENT, ALBUQUERQUE, NM 87109-4373
(505) 468-5604
(505) 468-4681
Taxonomy
Speciality
Code
Description
License number
State
311500000X
Alzheimer Center (Dementia Center)
Primary
—
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
12503348
—
KY
05
—
7100002190
—
KY
Enumeration date
08/31/2006
Last updated
08/25/2016
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