Organization
J & R LAGRANGE, LLC
Active
Other names
THE RICHWOOD
Organization subpart
No
Provider details
NPI number
Authorized official
MARK BOWMAN (PRESIDENT)
(859) 272-6682
Entity
Organization
Contact information
Practice address
1012 RICHWOOD WAY, LAGRANGE, KY 40031-8930
(502) 222-3186
(502) 222-6535
Mailing address
1012 RICHWOOD WAY, LAGRANGE, KY 40031-8930
(502) 222-3186
(502) 222-6535
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
314000000X
Skilled Nursing Facility
Primary
100818
KY
332B00000X
Durable Medical Equipment & Medical Supplies
100818
KY
332BN1400X
Nursing Facility Supplies (DME)
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
100818
KY
335E00000X
Prosthetic/Orthotic Supplier
100818
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000054853
ANTHEM BC/BS
KY
05
—
12503413
—
KY
01
—
2702411000
PASSPORT ADVANTAGE
KY
Enumeration date
09/28/2006
Last updated
06/24/2008
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