# DOVER MANOR, INC.

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

## Provider details

- **NPI number:** 1922001148
- **Authorized official:** MRS. DEBORAH J MCINTOSH (ASSISTANT CONTROLLER)
- **Authorized official phone:** (270) 338-2401

## Contact information

- **Practice address:** 112 DOVER DR, GEORGETOWN, KY 40324-9741
- **Practice address phone:** (502) 863-9529
- **Mailing address:** PO BOX 529, GREENVILLE, KY 42345-0529
- **Mailing address phone:** (270) 338-2401
- **Mailing address fax:** (270) 338-2405

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 100480 | KY | Yes |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 90003377 | KY | — |

## Other

- **Enumeration date:** 05/23/2005
- **Last updated:** 08/18/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000271318 | ANTHEM BLUE CROSS | KY |
| 01 | — | 000000316058 | ANTHEM BLUE CROSS PART B | KY |
| 05 | — | 12501755 | — | KY |
| 05 | — | 90003377 | — | KY |