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Organization
MASONIC HOMES OF KENTUCKY INC
Active
Organization
MASONIC HOMES OF KENTUCKY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DEBRA FINNERAN R.N. (ADMINISTRATOR)
(502) 633-3486
Entity
Organization
Contact information
Practice address
711 FRANKFORT RD, SHELBYVILLE, KY 40065-9447
(502) 633-3486
(502) 633-0661
Mailing address
711 FRANKFORT RD, P.O. BOX 909, SHELBYVILLE, KY 40065-9447
(502) 633-3486
(502) 633-0661
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
100386
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000054519
ANTHEM PROVIDER NUMBER
KY
05
—
12502571
—
KY
01
—
2438960000
PASSPORT ADVANTAGE
KY
01
—
5394544
AETNA PROVIDER NUMBER
KY
Enumeration date
07/25/2006
Last updated
12/22/2008
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