Organization
CREEKWOOD PLACE NURSING & REHAB CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID RODMAN (ASST SECRETARY)
(407) 975-3011
Entity
Organization
Contact information
Practice address
107 BOYLES DR, RUSSELLVILLE, KY 42276-8838
(270) 726-9049
(270) 726-8706
Mailing address
485 N KELLER RD, SUITE 250, MAITLAND, FL 32751-7503
(407) 975-3000
(407) 975-3090
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
100299
KY
332B00000X
Durable Medical Equipment & Medical Supplies
90003948
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100025410
—
KY
05
—
90003948
—
KY
Enumeration date
07/30/2006
Last updated
12/30/2015
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