Organization
SHADY LAWN OPCO LLC
Active
Other names
Shady Lawn Nursing and Rehabilitation Center
Organization subpart
No
Provider details
NPI number
Authorized official
MOSHE KELMAN (MANAGING MEMBER)
(270) 522-3236
Entity
Organization
Contact information
Practice address
2582 CERULEAN RD, CADIZ, KY 42211-9605
(270) 522-3236
(270) 522-0825
Mailing address
2582 CERULEAN RD, CADIZ, KY 42211-9605
(270) 522-3236
(270) 522-0825
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100396
LICENSE
KY
05
—
7100584170
—
KY
Enumeration date
10/02/2018
Last updated
09/01/2022
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