=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700158920
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMMONWEALTH OF KENTUCKY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/03/2012
-----------------------------------------------------
Last Update Date | 03/10/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 VETERANS DR
-----------------------------------------------------
City | HAZARD
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41701-9484
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-435-6196
-----------------------------------------------------
Fax | 606-435-6201
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 VETERANS DR
-----------------------------------------------------
City | HAZARD
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41701-9484
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-435-6196
-----------------------------------------------------
Fax | 606-435-6201
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MR. NEIL NAPIER
-----------------------------------------------------
Credential | LNHA
-----------------------------------------------------
Telephone | 606-435-6196
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 100990
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 313M00000X
-----------------------------------------------------
Taxonomy Name | Nursing Facility/Intermediate Care Facility
-----------------------------------------------------
License Number | 100990
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------