Healthcare Provider Details

I. General information

NPI: 1124121033
Provider Name (Legal Business Name): HAZARD NURSING HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 05/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 PARK AVE.
HAZARD KY
41701
US

IV. Provider business mailing address

PO BOX 1329
HAZARD KY
41702-1329
US

V. Phone/Fax

Practice location:
  • Phone: 606-439-2306
  • Fax: 606-439-2275
Mailing address:
  • Phone: 606-439-2306
  • Fax: 606-439-2275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number100462
License Number StateKY

VIII. Authorized Official

Name: MR. TERRY EMANUEL FORCHT
Title or Position: CHAIRMAN
Credential:
Phone: 606-528-9600