Provider Demographics
NPI:1689414294
Name:ONE SENIOR CARE KENTUCKY, LLC
Entity type:Organization
Organization Name:ONE SENIOR CARE KENTUCKY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-456-5433
Mailing Address - Street 1:100 STATE ST STE 200
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1454
Mailing Address - Country:US
Mailing Address - Phone:814-456-5433
Mailing Address - Fax:814-454-2500
Practice Address - Street 1:419 TOWN MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1631
Practice Address - Country:US
Practice Address - Phone:606-727-2690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ONE SENIOR CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization