Organization
BREATITT COUNTY GERIATRIC CORPORATION
Active
Other names
nim henson geriatric center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PHILLIP LITTERAL (ADMINISTRATOR)
(606) 666-2456
Entity
Organization
Contact information
Practice address
420 JETT DR, JACKSON, KY 41339-9621
(606) 666-2456
(606) 666-9376
Mailing address
420 JETT DR, JACKSON, KY 41339-9621
(606) 666-2456
(606) 666-9376
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
KY100040
KY
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
KY100040
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000054703
BLUE CROSS BLUE SHIELD
KY
05
—
12501524
—
KY
01
—
543892824
BLACK LUNG
KY
05
—
9013013900
—
KY
Enumeration date
11/08/2006
Last updated
07/17/2008
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