Healthcare Provider Details

I. General information

NPI: 1104891662
Provider Name (Legal Business Name): WELLINGTON PARC HEALTH SYSTEMS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4747 ALBEN BARKLEY DR
PADUCAH KY
42001-6789
US

IV. Provider business mailing address

725 HARVARD DR
OWENSBORO KY
42301-6185
US

V. Phone/Fax

Practice location:
  • Phone: 270-534-0620
  • Fax: 270-534-0821
Mailing address:
  • Phone: 270-926-9355
  • Fax: 270-684-6283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number100875
License Number StateKY

VIII. Authorized Official

Name: MR. TERRY LYNN SKAGGS
Title or Position: CFO
Credential:
Phone: 270-926-9355