# HBR CAMPBELL LANE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** HBR KENTUCKY LLC
- **Other names:** Magnolia Village
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1144331216
- **Legal business name:** HBR KENTUCKY LLC
- **Authorized official:** MICHAEL T BERG (ASSISTANT SECRETARY)
- **Authorized official phone:** (505) 821-3355

## Contact information

- **Practice address:** 1381 CAMPBELL LN, BOWLING GREEN, KY 42104-1049
- **Practice address phone:** (270) 843-0587
- **Practice address fax:** (270) 843-0874
- **Mailing address:** 101 SUN AVE NE, COMPLIANCE DEPARTMENT, ALBUQUERQUE, NM 87109-4373
- **Mailing address phone:** (505) 468-5604
- **Mailing address fax:** (505) 468-4681

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311500000X | Alzheimer Center (Dementia Center) | — | KY | Yes |

## Other

- **Enumeration date:** 08/31/2006
- **Last updated:** 08/25/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 12503348 | — | KY |
| 05 | — | 7100002190 | — | KY |