=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801894118
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WELLS HEALTH SYSTEMS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2005
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 225 SAINT JOHN RD
-----------------------------------------------------
City | ELIZABETHTOWN
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42701-2918
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-769-3314
-----------------------------------------------------
Fax | 270-360-1185
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 725 HARVARD DR
-----------------------------------------------------
City | OWENSBORO
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42301-6185
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-926-9355
-----------------------------------------------------
Fax | 270-684-6283
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | MR. TERRY LYNN SKAGGS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 270-926-9355
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 100158
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------