Provider Demographics
NPI:1982604518
Name:PAINTSVILLE INVESTORS, LLC
Entity type:Organization
Organization Name:PAINTSVILLE INVESTORS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:REGENEA
Authorized Official - Last Name:JONES-GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:CSW/LNHA
Authorized Official - Phone:606-789-5808
Mailing Address - Street 1:1025 EUCLID AVENUE
Mailing Address - Street 2:
Mailing Address - City:PAINTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41240
Mailing Address - Country:US
Mailing Address - Phone:606-789-5808
Mailing Address - Fax:606-789-1813
Practice Address - Street 1:1025 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:PAINTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41240-8645
Practice Address - Country:US
Practice Address - Phone:606-789-5808
Practice Address - Fax:606-789-1813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100688314000000X
KY7100209150343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY12502977Medicaid
KY185414Medicare ID - Type Unspecified
KY1034790001Medicare NSC