SNH DERBY TENANT LLC (NPI# 1275182453) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275182453 |
| Entity Type | Organization |
| Organization Name | SNH DERBY TENANT LLC |
| Practice Address |
200 Brookside Dr Louisville KY 40243-1200 |
| Mailing Address |
255 Washington St Ste 300 Newton MA 02458-1634 |
| Practice Telephone | 5022453048 |
| Practice Fax Number | 5022446327 |
| Mailing Telephone | 6177968350 |
| Enumeration Date | 2019-09-10 |
| Last Update Date | 2020-05-04 |
| Authorized Official Name | JENNIFER F. MINTZER (PRESIDENT & CHIEF OPERATING OFFICER) |
| Authorized Official Telephone | 6177968350 |
| Is Organization Subpart | Y |
| Parent Organization Name | SNH DERBY TENANT LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 310400000X | Assisted Living Facility | Nursing & Custodial Care Facilities | ||
| Y | 314000000X | Skilled Nursing Facility | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KY | PENDING | 05 |
| Other Name | Type Code |
|---|---|
| The Forum at Brookside | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508415787 | Snh Derby Tenant LLC | Assisted Living Facility | 690 Mason Headley Rd, Lexington, KY 40504-2384 | 2019-09-10 |
| 1760031959 | Snh Derby Tenant LLC | Assisted Living Facility | 1517 West Broadway Street, Mayfield, KY 42066 | 2019-09-10 |
| 1326698234 | Snh Derby Tenant LLC | Assisted Living Facility | 700 Mason Headley Rd, Lexington, KY 40504-2326 | 2019-09-13 |
| 1780233973 | Snh Derby Tenant LLC | Assisted Living Facility | 4190 Lafayette Rd, Hopkinsville, KY 42240-5366 | 2019-09-10 |
| 1134778327 | Snh Derby Tenant LLC | Assisted Living Facility | 1700 Elmdale Rd, Paducah, KY 42003-5517 | 2019-09-10 |
| 1881243061 | Snh Derby Tenant LLC | Assisted Living Facility | 981 Campbell Ln, Bowling Green, KY 42104-4136 | 2019-09-10 |
| 1679122865 | Snh Derby Tenant LLC | Assisted Living Facility | 100 Neighborly Way, Somerset, KY 42503-6147 | 2019-09-10 |
| Street Address |
200 BROOKSIDE DR |
| City | LOUISVILLE |
| State | KY |
| Zip Code | 40243-1200 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811942881 | Five Star Brookside LLC | Skilled Nursing Facility | 200 Brookside Dr, Louisville, KY 40243-1277 | 2006-05-24 |
| 1871677310 | Five Star Rehabilitation and Wellness Services, LLC. | Clinic/Center | 200 Brookside Dr, Louisville, KY 40243-1277 | 2006-10-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942801949 | Pulsemer Health LLC | Clinic/Center | 11408 Shelbyville Rd, Suite 2, Louisville, KY 40243 | 2020-11-05 |
| 1316563372 | Molly Elizabeth Fitzgerald | Counselor | 350 Evergreen Road Suite 102, Louisville, KY 40243 | 2020-06-24 |
| 1215575410 | Eric Wolfe | Pharmacist | 1320 Snake Foot Drive, Apt 204, Louisville, KY 40243 | 2019-12-18 |
| 1417501974 | Joshua Bynum | Physical Therapist | 12935 Shelbyville Road Ste 106, Louisville, KY 40243 | 2019-08-01 |
| 1376013342 | Carmen Sue Frederick | Psychologist | 731 Speckman Road, Louisville, KY 40243 | 2018-12-03 |
| 1205366846 | Triple Crown Dentistry | Dentist | 904 Lily Creek Road, Suite 101, Louisville, KY 40243 | 2017-06-15 |
| 1659811636 | Jean Steltenpohl | Dietitian, Registered | 518 Cheskirk Pl, Louisville, KY 40243 | 2017-02-24 |
| 1548555287 | Jonathan D Senters | Pharmacist | 12975 Shelbyville Road, T-2728, Middletown, KY 40243 | 2011-06-10 |
| 1023339835 | Ashley Rose Havens | Speech-Language Pathologist | 11510 Main Street, Louisville, KY 40243 | 2010-06-15 |
| 1801110424 | Shawna L. Kauffman | Family Medicine | 12955 Shelbyville Rd Ste 2, Louisville, KY 40243 | 2010-03-25 |
| Find all providers in zip 40243 | ||||
| Taxonomy Code | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255980876 | Ehcs Oakhill Properties, LLC | Skilled Nursing Facility | 4466 Lynnhaven Ave, Louisville, OH 44641-9513 | 2019-09-06 |
| 1740710623 | Landmark of Louisville Rehabilitation and Nursing Center | Skilled Nursing Facility | 1155 Eastern Parkway, Louisville, KY 40217 | 2017-06-14 |
| 1225405475 | Blount County Snf Operations, LLC | Skilled Nursing Facility | 1965 Stewart Lane, Louisville, TN 37777 | 2015-08-24 |
| 1952788408 | Bridgett Powers Mattingly | Skilled Nursing Facility | 117 Weisser Ave, Louisville, KY 40206-2761 | 2015-05-05 |
| 1235527300 | Trilogy Healthcare of Louisville Northeast, LLC | Skilled Nursing Facility | 4120 Wooded Acre Ln, Louisville, KY 40245-2938 | 2014-12-24 |
| 1215330345 | Jonathan Kratzwald | Skilled Nursing Facility | 8206 Happiness Way, Louisville, KY 40291-2865 | 2014-10-03 |
| 1043659626 | Niraj Mathur | Skilled Nursing Facility | 4209 Bridlepath Pl, Louisville, KY 40245-1971 | 2013-06-18 |
| 1235574161 | Balfour Retirement Community of Boulder County | Skilled Nursing Facility | 1855 Plaza Dr., Louisville, CO 80027 | 2013-05-06 |
| 1164703955 | Christian Health Center - West, Inc. | Skilled Nursing Facility | 1015 Magazine St, Louisville, KY 40203-2017 | 2011-09-07 |
| 1801193560 | Trilogy Healthcare of Louisville East, LLC | Skilled Nursing Facility | 4247 Westport Rd, Louisville, KY 40207-2227 | 2011-02-16 |
| Find all providers in LOUISVILLE | ||||
| City | LOUISVILLE |
| Zip Code | 40243 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.