Organization
MASONIC HOMES OF KENTUCKY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TODD L. LACY (CFO)
(502) 753-8802
Entity
Organization
Contact information
Practice address
240 MASONIC HOME DR, MASONIC HOME, KY 40041-9000
(502) 897-4907
(502) 259-5290
Mailing address
240 MASONIC HOME DR, MASONIC HOME, KY 40041-9000
(502) 897-4907
(502) 259-5290
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
100225
KY
320700000X
Physical Disabilities Residential Treatment Facility
760006
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000054518
ANTHEM
KY
05
—
12502662
—
KY
Enumeration date
07/21/2006
Last updated
10/14/2011
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