Healthcare Provider Details

I. General information

NPI: 1336205897
Provider Name (Legal Business Name): MARSHALL COUNTY HOSPITAL LONG TERM CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 GEORGE MCCLAIN DR
BENTON KY
42025-1331
US

IV. Provider business mailing address

503 GEORGE MCCLAIN DR
BENTON KY
42025-1331
US

V. Phone/Fax

Practice location:
  • Phone: 270-527-4800
  • Fax: 270-527-4853
Mailing address:
  • Phone: 270-527-4800
  • Fax: 270-527-4853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number100328
License Number StateKY

VIII. Authorized Official

Name: KATHY LONG
Title or Position: ADMINISTRATOR
Credential:
Phone: 270-527-4800