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Organization
PINE MEADOWS HEALTH CARE, LLC
Active
Organization
PINE MEADOWS HEALTH CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK BOWMAN (PRESIDENT)
(859) 272-6682
Entity
Organization
Contact information
Practice address
1608 HILL RISE DR, LEXINGTON, KY 40504-2503
(859) 254-2402
Mailing address
1608 HILL RISE DR, LEXINGTON, KY 40504-2503
(859) 254-2402
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
100638
KY
332B00000X
Durable Medical Equipment & Medical Supplies
100638
KY
332BN1400X
Nursing Facility Supplies (DME)
—
NULL
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
100638
KY
335E00000X
Prosthetic/Orthotic Supplier
100638
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000054920
ANTHEM BC/BS
KY
05
—
12504684
—
KY
Enumeration date
09/12/2006
Last updated
10/02/2007
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