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General NPI Number Information
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NPI Number | 1114926854
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Entity Type | Organization
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Legal Business Name | GRAYSON COUNTY HOSPITAL FOUNDATION INC.
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Dates
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Enumeration Date | 07/15/2005
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Last Update Date | 06/25/2008
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Provider Practice Location Address
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Address Line | 910 WALLACE AVE
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City | LEITCHFIELD
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State | KY
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Zip | 42754-1418
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Country | US
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Telephone | 270-259-9525
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Fax | 270-259-1670
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Provider Business Mailing Address
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Address Line | 910 WALLACE AVE
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City | LEITCHFIELD
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State | KY
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Zip | 42754-1418
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Country | US
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Telephone | 270-259-9525
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Fax | 270-259-1670
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Authorized Official
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Title or Position | DIRECTOR OF HOME HEALTH
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Name | MRS. MONA GAIL FULKERSON
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Credential | RN
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Telephone | 270-259-9525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251X00000X
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Taxonomy Name | Supports Brokerage Agency
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License Number | 150102
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 150102
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License Number State | KY
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