Healthcare Provider Details

I. General information

NPI: 1063784197
Provider Name (Legal Business Name): COMMONWEALTH OF KENTUCKY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2012
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

926 VETERANS DR
HANSON KY
42413-9401
US

IV. Provider business mailing address

926 VETERANS DR
HANSON KY
42413-9401
US

V. Phone/Fax

Practice location:
  • Phone: 270-322-9087
  • Fax: 270-322-9497
Mailing address:
  • Phone: 270-322-3566
  • Fax: 270-322-9497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number100978
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number100978
License Number StateKY

VIII. Authorized Official

Name: LADONNA LYNN SCOTT
Title or Position: LNHA
Credential:
Phone: 270-322-3566