Healthcare Provider Details

I. General information

NPI: 1851449243
Provider Name (Legal Business Name): MARSHALL COUNTY HOSPITAL AND LONG TERM CARE FACILITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 05/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 GEORGE MCCLAIN DR
BENTON KY
42025-1365
US

IV. Provider business mailing address

501 GEORGE MCCLAIN DR PO BOX 630
BENTON KY
42025-1365
US

V. Phone/Fax

Practice location:
  • Phone: 270-527-8084
  • Fax: 270-527-9474
Mailing address:
  • Phone: 270-527-8084
  • Fax: 270-527-9474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number150168
License Number StateKY

VIII. Authorized Official

Name: SUSAN GREEN
Title or Position: OFFICE MANAGER BILLER
Credential:
Phone: 270-527-8084