MEDICARE: WELLINGTON PARC HEALTH SYSTEMS, INC.

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
1	314000000X	Skilled Nursing Facility	100648	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598763898
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLINGTON PARC HEALTH SYSTEMS, INC.

Provider Business Mailing Address
First Line	:	725 HARVARD DR
Second Line	:
City	:	OWENSBORO
State	:	KY
Zip	:	42301-6185
Country	:	US
Telephone Number	:	270-926-9355
Fax Number	:	270-684-6283

Provider Business Practice Location Address
First Line	:	2885 NEW HARTFORD RD
Second Line	:
City	:	OWENSBORO
State	:	KY
Zip	:	42303-1320
Country	:	US
Telephone Number	:	270-685-2374
Fax Number	:	270-926-8510

Authorized Official
Title or Position	:	CFO
Name	:	MR. TERRY LYNN SKAGGS
Credential	:
Telephone Number	:	270-926-9355

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	04/16/2008

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