Healthcare Provider Details

I. General information

NPI: 1447272216
Provider Name (Legal Business Name): PINEVILLE COMMUNITY HOSPITAL ASSOCIATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/12/2022
Certification Date: 07/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 RIVERVIEW RD
PINEVILLE KY
40977-1430
US

IV. Provider business mailing address

850 RIVERVIEW RD
PINEVILLE KY
40977-1430
US

V. Phone/Fax

Practice location:
  • Phone: 606-337-3051
  • Fax: 606-337-2871
Mailing address:
  • Phone: 606-337-3051
  • Fax: 606-337-2871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number100725
License Number StateKY

VIII. Authorized Official

Name: KEVIN COUCH
Title or Position: CONTROLLER
Credential:
Phone: 606-337-4282