- Enrollment id
- O20200122002847
- Enrollment state
- KY
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1477101889
- Multiple npi flag
- N
- Ccn
- 185222
- Associate id
- 5496180333
- Organization name
- PHELPS KY OPCO LLC
- Doing business as name
- GOOD SHEPHERD HEALTH AND REHABILITATION
- Incorporation date
- 2019-08-28
- Incorporation state
- DE
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- GOOD SHEPHERD HEALTH AND REHABILITATION
- Affiliation entity name
- PLAINVIEW HEALTHCARE PARTNERS
- Affiliation entity id
- 657
- Address line 1
- 60 PHILLIPS BRANCH RD
- City
- PHELPS
- State
- KY
- Zip code
- 415539061