Organization
DOVER MANOR, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DEBORAH J MCINTOSH (ASSISTANT CONTROLLER)
(270) 338-2401
Entity
Organization
Contact information
Practice address
112 DOVER DR, GEORGETOWN, KY 40324-9741
(502) 863-9529
Mailing address
PO BOX 529, GREENVILLE, KY 42345-0529
(270) 338-2401
(270) 338-2405
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
100480
KY
332B00000X
Durable Medical Equipment & Medical Supplies
90003377
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000271318
ANTHEM BLUE CROSS
KY
01
—
000000316058
ANTHEM BLUE CROSS PART B
KY
05
—
12501755
—
KY
05
—
90003377
—
KY
Enumeration date
05/23/2005
Last updated
08/18/2008
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