Healthcare Provider Details

I. General information

NPI: 1255372686
Provider Name (Legal Business Name): OUR LADY OF BELLEFONTE HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 05/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 SAINT CHRISTOPHER DR MEDICAL BUILDING III, SUITE 105
ASHLAND KY
41101-7062
US

IV. Provider business mailing address

700 SAINT CHRISTOPHER DR MEDICAL BUILDING III, SUITE 105
ASHLAND KY
41101-7062
US

V. Phone/Fax

Practice location:
  • Phone: 606-833-3545
  • Fax: 606-833-3546
Mailing address:
  • Phone: 606-833-3545
  • Fax: 606-833-3546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number150098
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number150098
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number150098
License Number StateKY

VIII. Authorized Official

Name: LAURA BUCZKOWSKI
Title or Position: CFO
Credential:
Phone: 804-627-5573