# J & R LAGRANGE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** THE RICHWOOD
- **Organization subpart:** No

## Provider details

- **NPI number:** 1700978806
- **Authorized official:** MARK BOWMAN (PRESIDENT)
- **Authorized official phone:** (859) 272-6682

## Contact information

- **Practice address:** 1012 RICHWOOD WAY, LAGRANGE, KY 40031-8930
- **Practice address phone:** (502) 222-3186
- **Practice address fax:** (502) 222-6535
- **Mailing address:** 1012 RICHWOOD WAY, LAGRANGE, KY 40031-8930
- **Mailing address phone:** (502) 222-3186
- **Mailing address fax:** (502) 222-6535

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | — |
| 225100000X | Physical Therapist | — | — | — |
| 225X00000X | Occupational Therapist | — | NULL | — |
| 225X00000X | Occupational Therapist | — | — | — |
| 235Z00000X | Speech-Language Pathologist | — | NULL | — |
| 235Z00000X | Speech-Language Pathologist | — | — | — |
| 314000000X | Skilled Nursing Facility | 100818 | KY | Yes |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 100818 | KY | — |
| 332BN1400X | Nursing Facility Supplies (DME) | — | NULL | — |
| 332BP3500X | Parenteral & Enteral Nutrition Supplies (DME) | 100818 | KY | — |
| 335E00000X | Prosthetic/Orthotic Supplier | 100818 | KY | — |

## Other

- **Enumeration date:** 09/28/2006
- **Last updated:** 06/24/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000054853 | ANTHEM BC/BS | KY |
| 05 | — | 12503413 | — | KY |
| 01 | — | 2702411000 | PASSPORT ADVANTAGE | KY |