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Organization
SHADY LAWN OPCO LLC
Active
Organization
SHADY LAWN OPCO LLC
Active
Other names
Shady Lawn Nursing and Rehabilitation Center
Organization subpart
No
Provider details
NPI number
Authorized official
MOSHE KELMAN (MANAGING MEMBER)
(270) 522-3236
Entity
Organization
Contact information
Practice address
2582 CERULEAN RD, CADIZ, KY 42211-9605
(270) 522-3236
(270) 522-0825
Mailing address
2582 CERULEAN RD, CADIZ, KY 42211-9605
(270) 522-3236
(270) 522-0825
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100396
LICENSE
KY
05
—
7100584170
—
KY
Enumeration date
10/02/2018
Last updated
09/01/2022
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