# CREEKWOOD PLACE NURSING & REHAB CENTER, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619982410
- **Authorized official:** MR. DAVID RODMAN (ASST SECRETARY)
- **Authorized official phone:** (407) 975-3011

## Contact information

- **Practice address:** 107 BOYLES DR, RUSSELLVILLE, KY 42276-8838
- **Practice address phone:** (270) 726-9049
- **Practice address fax:** (270) 726-8706
- **Mailing address:** 485 N KELLER RD, SUITE 250, MAITLAND, FL 32751-7503
- **Mailing address phone:** (407) 975-3000
- **Mailing address fax:** (407) 975-3090

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 100299 | KY | Yes |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 90003948 | KY | — |

## Other

- **Enumeration date:** 07/30/2006
- **Last updated:** 12/30/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 7100025410 | — | KY |
| 05 | — | 90003948 | — | KY |