Healthcare Provider Details

I. General information

NPI: 1609586122
Provider Name (Legal Business Name): OHANA CARE OF LAKE CUMBERLAND, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2022
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 W COLUMBIA ST
SOMERSET KY
42501-1618
US

IV. Provider business mailing address

650 S HIGHWAY 27 # 308
SOMERSET KY
42501-3501
US

V. Phone/Fax

Practice location:
  • Phone: 606-331-5328
  • Fax: 859-207-6700
Mailing address:
  • Phone: 606-331-5328
  • Fax: 859-207-6700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SARA BETH PENCE
Title or Position: OWNER/APRN
Credential:
Phone: 606-331-5328