Organization
PIONEER TRACE GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KIMBERLY SMITH NHA (CFO/MEMBER)
(270) 839-1589
Entity
Organization
Contact information
Practice address
115 PIONEER TRCE, FLEMINGSBURG, KY 41041-9665
(606) 845-2131
(606) 845-3507
Mailing address
115 PIONEER TRCE, FLEMINGSBURG, KY 41041-9665
(606) 845-2131
(606) 845-3507
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
100484
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100484
FACILITY LICENSE
KY
Enumeration date
10/28/2016
Last updated
11/01/2016
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