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General NPI Number Information
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NPI Number | 1396962551
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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 | 04/19/2007
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Last Update Date | 08/01/2012
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Provider Practice Location Address
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Address Line | 200 VETERANS DR
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City | HAZARD
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State | KY
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Zip | 41701-9484
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Country | US
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Telephone | 606-345-6196
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Fax | 606-435-6201
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Provider Business Mailing Address
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Address Line | 200 VETERANS DR
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City | HAZARD
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State | KY
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Zip | 41701-9484
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Country | US
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Telephone | 606-345-6196
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Fax | 606-435-6201
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. JUDITH CAROLYN BRANHAM
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Credential | LNHA
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Telephone | 606-435-6196
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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 | 100990
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License Number State | KY
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