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NPI Code Detail

MEDICARE: KENTUCKY CORRECTIONAL PSYCHIATRIC CENTER

MEDICARE: KENTUCKY CORRECTIONAL PSYCHIATRIC CENTER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1283X00000XRehabilitation Hospital100528KY

General Provider Information

NPI Number : 1518962356
Entity Type Code : Organization
Provider Name (Legal Business Name) : KENTUCKY CORRECTIONAL PSYCHIATRIC CENTER
Provider Business Mailing Address
First Line : 1612 DAWKINS RD
Second Line :
City : LA GRANGE
State : KY
Zip : 40031-8729
Country : US
Telephone Number : 502-222-7161
Fax Number : 502-222-7798
Provider Business Practice Location Address
First Line : 1612 DAWKINS RD
Second Line :
City : LA GRANGE
State : KY
Zip : 40031-8729
Country : US
Telephone Number : 502-222-7161
Fax Number : 502-222-7798
Authorized Official
Title or Position : ASSOCIATE SUPERINTENDENT
Name : MRS. SHARON W. PROCTOR
Credential : RHIA
Telephone Number : 502-222-7163
Provider Enumeration Date : 06/17/2005
Last Update Date : 08/22/2020

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Directions to “KENTUCKY CORRECTIONAL PSYCHIATRIC CENTER ” Practice Location

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