Healthcare Provider Details

I. General information

NPI: 1659595304
Provider Name (Legal Business Name): ROCKCASTLE COUNTY ADULT HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 07/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 S. WILDERNESS ROAD
MOUNT VERNON KY
40456
US

IV. Provider business mailing address

1260 S. WILDERNESS RD
MT. VERNON KY
40456
US

V. Phone/Fax

Practice location:
  • Phone: 606-256-4316
  • Fax: 606-256-1626
Mailing address:
  • Phone: 606-256-4316
  • Fax: 606-256-1626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number750080
License Number StateKY

VIII. Authorized Official

Name: MRS. BRENDA CABLE
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 606-256-4316