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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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