Provider Demographics
NPI:1679912125
Name:CHRISTIAN COUNTY MANOR, LLC
Entity type:Organization
Organization Name:CHRISTIAN COUNTY MANOR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/CO OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:SEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:ATTORNEY AT LAW
Authorized Official - Phone:502-891-4483
Mailing Address - Street 1:4500 BOWLING BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-5147
Mailing Address - Country:US
Mailing Address - Phone:502-891-4483
Mailing Address - Fax:
Practice Address - Street 1:2820 RICHARD ST
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-1670
Practice Address - Country:US
Practice Address - Phone:270-886-9900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY019311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home