=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780126607
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAINT JOSEPH HEALTH SYSTEM, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/09/2016
-----------------------------------------------------
Last Update Date | 11/30/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 JB SHANNON DRIVE
-----------------------------------------------------
City | FLEMINGSBURG
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41041-9812
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-209-0016
-----------------------------------------------------
Fax | 606-209-0022
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 SAINT JOSEPH DR
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40504-3742
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-313-1000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SECRETARY
-----------------------------------------------------
Name | SHARON HAGER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 502-569-7974
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0401X
-----------------------------------------------------
Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------