1659595304 NPI number — ROCKCASTLE COUNTY ADULT HEALTH CARE

Table of content: (NPI 1659595304)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659595304 NPI number — ROCKCASTLE COUNTY ADULT HEALTH CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROCKCASTLE COUNTY ADULT HEALTH CARE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659595304
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/22/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1260 S. WILDERNESS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MT. VERNON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40456
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-256-4316
Provider Business Mailing Address Fax Number:
606-256-1626

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1260 S. WILDERNESS ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT VERNON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-256-4316
Provider Business Practice Location Address Fax Number:
606-256-1626
Provider Enumeration Date:
04/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CABLE
Authorized Official First Name:
BRENDA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
606-256-4316

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X , with the licence number:  750080 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 43001023 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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