Healthcare Provider Details

I. General information

NPI: 1457335390
Provider Name (Legal Business Name): BEREA HOSPITAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 ESTILL ST
BEREA KY
40403-1742
US

IV. Provider business mailing address

305 ESTILL ST
BEREA KY
40403-1742
US

V. Phone/Fax

Practice location:
  • Phone: 859-986-6500
  • Fax: 859-986-6317
Mailing address:
  • Phone: 859-986-6500
  • Fax: 859-986-6317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number100318
License Number StateKY

VIII. Authorized Official

Name: ANGELA P. CARMAN
Title or Position: PRESIDENT/CEO
Credential:
Phone: 859-986-6500