# N/A

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

## Provider details

- **NPI number:** 1871868927
- **Authorized official:** TAMMY GAYLE BERRY (RN)
- **Authorized official phone:** (812) 697-1016

## Contact information

- **Practice address:** 3108 ISLAND CT, JEFFERSONVILLE, IN 47130-8058
- **Practice address phone:** (812) 697-1016
- **Mailing address:** 3108 ISLAND CT, JEFFERSONVILLE, IN 47130-8058
- **Mailing address phone:** (812) 697-1016

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 1106110 | KY | Yes |

## Other

- **Enumeration date:** 03/21/2012
- **Last updated:** 03/21/2012