Organization
NEW JACKSON MANOR, LLC
Active
Organization
NEW JACKSON MANOR, LLC
Active
Other names
Annville Adult Day Healthcare Center
Organization subpart
No
Provider details
NPI number
Authorized official
ROBIN L. BARBER J.D. (VICE PRESIDENT)
(502) 753-6004
Entity
Organization
Contact information
Practice address
68 HWY 3444, ANNVILLE, KY 40402
(606) 364-5197
(606) 364-2293
Mailing address
9510 ORMSBY STATION ROAD, SUITE 101, LOUISVILLE, KY 40223
(502) 753-6004
(502) 753-6104
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
Primary
750066
KY
261QA0600X
Adult Day Care Clinic/Center
—
—
314000000X
Skilled Nursing Facility
100602
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100174140
—
KY
Enumeration date
10/20/2005
Last updated
10/23/2012
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