=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831568062
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARMELITE SISTERS OF THE DIVINE HEART OF JESUS KENTUCKY CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2015
-----------------------------------------------------
Last Update Date | 09/17/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2501 OLD HARTFORD RD
-----------------------------------------------------
City | OWENSBORO
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42303-1339
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-683-0227
-----------------------------------------------------
Fax | 270-685-3406
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2501 OLD HARTFORD RD
-----------------------------------------------------
City | OWENSBORO
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42303-1339
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-683-0227
-----------------------------------------------------
Fax | 270-685-3406
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | SR. M. FRANCIS TERES SCULLY
-----------------------------------------------------
Credential | ADMINISTRATOR
-----------------------------------------------------
Telephone | 270-685-3406
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------