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General NPI Number Information
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NPI Number | 1366447609
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Entity Type | Organization
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Legal Business Name | CENTRAL STATE HOSPITAL
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Dates
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Enumeration Date | 06/14/2005
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Last Update Date | 07/30/2010
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Provider Practice Location Address
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Address Line | 10510 LAGRANGE RD
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City | LOUISVILLE
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State | KY
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Zip | 40223-1277
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Country | US
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Telephone | 502-253-7135
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Fax | 502-253-7044
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Provider Business Mailing Address
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Address Line | 10510 LAGRANGE ROAD
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City | LOUISVILLE
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State | KY
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Zip | 40223-1277
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Country | US
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Telephone |
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Fax | 502-253-7044
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Authorized Official
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Title or Position | CONTROLLER
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Name | MARK L REYNOLDS
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Credential |
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Telephone | 502-253-7135
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number | 100198
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License Number State | KY
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