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General NPI Number Information
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NPI Number | 1316751431
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Entity Type | Organization
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Legal Business Name | COMMONWEALTH OF KENTUCKY
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Dates
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Enumeration Date | 02/07/2025
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Last Update Date | 02/07/2025
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Provider Practice Location Address
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Address Line | 1111 VETERANS WAY
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City | BOWLING GREEN
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State | KY
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Zip | 42101-6714
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Country | US
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Telephone | 270-535-5471
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Fax |
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Provider Business Mailing Address
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Address Line | 1111 VETERANS WAY
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City | BOWLING GREEN
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State | KY
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Zip | 42101-6714
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Country | US
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Telephone | 270-535-5471
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JASON GUMM
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Credential |
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Telephone | 270-535-5471
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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