Healthcare Provider Details

I. General information

NPI: 1356313407
Provider Name (Legal Business Name): HOSPITAL OF LOUISA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HIGHWAY 644
LOUISA KY
41230
US

IV. Provider business mailing address

PO BOX 60990
SAINT LOUIS MO
63160-0990
US

V. Phone/Fax

Practice location:
  • Phone: 606-638-9451
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number100282
License Number StateKY

VIII. Authorized Official

Name: RANDY MICHAEL COOPER
Title or Position: SVP FINANCE OP/AUTHORIZED OFFICIAL
Credential:
Phone: 615-221-3840