1316934193 NPI number — BRIGHTON CORNERSTONE HEALTH CARE

Table of content: (NPI 1316934193)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316934193 NPI number — BRIGHTON CORNERSTONE HEALTH CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRIGHTON CORNERSTONE 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:
1316934193
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
55 E NORTH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MADISONVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42431-1643
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-821-1492
Provider Business Mailing Address Fax Number:
270-821-6946

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
55 E NORTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MADISONVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42431-1643
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-821-1492
Provider Business Practice Location Address Fax Number:
270-821-6946
Provider Enumeration Date:
10/05/2005

Additional Information

Authorized Official

Authorized Official Last Name:
C.
Authorized Official First Name:
VIKI
Authorized Official Middle Name:
THOMASSON
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
270-821-1492

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  100183 , 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: 12504783 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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