Organization
BOURBON HEIGHTS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CHARLOTTE LEE ROBERTS (ADMINISTRATOR)
(859) 987-5750
Entity
Organization
Contact information
Practice address
2000 MAIN ST, PARIS, KY 40361-1149
(859) 987-5750
(859) 987-6460
Mailing address
2000 MAIN ST, PARIS, KY 40361-1149
(859) 987-5750
(859) 987-6460
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
100024
KY
314000000X
Skilled Nursing Facility
100024
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000054629
ANTHEM BLUE CROSS BLUE SH
—
05
—
12501664
—
KY
01
—
19401888
SUMMIT WORKER'S COMP
—
Enumeration date
07/09/2006
Last updated
05/25/2016
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