# SHADY LAWN OPCO LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Shady Lawn Nursing and Rehabilitation Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720563034
- **Authorized official:** MOSHE KELMAN (MANAGING MEMBER)
- **Authorized official phone:** (270) 522-3236

## Contact information

- **Practice address:** 2582 CERULEAN RD, CADIZ, KY 42211-9605
- **Practice address phone:** (270) 522-3236
- **Practice address fax:** (270) 522-0825
- **Mailing address:** 2582 CERULEAN RD, CADIZ, KY 42211-9605
- **Mailing address phone:** (270) 522-3236
- **Mailing address fax:** (270) 522-0825

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 10/02/2018
- **Last updated:** 09/01/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 100396 | LICENSE | KY |
| 05 | — | 7100584170 | — | KY |