Healthcare Provider Details

I. General information

NPI: 1114929494
Provider Name (Legal Business Name): GRAYSON COUNTY HOSPITAL FOUNDATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 02/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 WALLACE AVE
LEITCHFIELD KY
42754-1418
US

IV. Provider business mailing address

910 WALLACE AVE
LEITCHFIELD KY
42754-1418
US

V. Phone/Fax

Practice location:
  • Phone: 270-259-9400
  • Fax: 270-259-9524
Mailing address:
  • Phone: 270-259-9400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number100151
License Number StateKY

VIII. Authorized Official

Name: CYNTHIA R BAILEY
Title or Position: REIMBURSEMENT ANALYST
Credential:
Phone: 270-259-1656