Healthcare Provider Details

I. General information

NPI: 1700158920
Provider Name (Legal Business Name): COMMONWEALTH OF KENTUCKY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2012
Last Update Date: 03/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 VETERANS DR
HAZARD KY
41701-9484
US

IV. Provider business mailing address

200 VETERANS DR
HAZARD KY
41701-9484
US

V. Phone/Fax

Practice location:
  • Phone: 606-435-6196
  • Fax: 606-435-6201
Mailing address:
  • Phone: 606-435-6196
  • Fax: 606-435-6201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number100990
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number100990
License Number StateKY

VIII. Authorized Official

Name: MR. NEIL NAPIER
Title or Position: ADMINISTRATOR
Credential: LNHA
Phone: 606-435-6196