Healthcare Provider Details

I. General information

NPI: 1104813880
Provider Name (Legal Business Name): PRESBYTERIAN HOMES AND SERVICES OF KENTUCKY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 PHILLIPS BRANCH RD
PHELPS KY
41553-9061
US

IV. Provider business mailing address

PO BOX 18067
LOUISVILLE KY
40261-0067
US

V. Phone/Fax

Practice location:
  • Phone: 502-259-9101
  • Fax: 502-259-9109
Mailing address:
  • Phone: 502-259-9101
  • Fax: 502-259-9109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number100516
License Number StateKY

VIII. Authorized Official

Name: HATTIE WAGNER
Title or Position: CEO/PRESIDENT
Credential:
Phone: 502-259-9101