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Contact Information

COMMONWEALTH OF KENTUCKY
2400 RUSSELLVILLE RD
US 68 EAST
HOPKINSVILLE, KY42241
 Phone: 502-886-4431
 Fax: 270-886-4487
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Psychiatry

2084P0800X 26 Physician/Psychiatry
 

Intermediate Care Facility, Mentally Retarded

315P00000X
 

Nursing Facility/Intermediate Care Facility

313M00000X A3[10] Other Nursing Facility
Indicates primary specialty

NPI Profile & details for COMMONWEALTH OF KENTUCKY

NPI Number 1134124167
LBN Legal business name COMMONWEALTH OF KENTUCKY
Authorized official JENNIFER MOORE - (ASSISTANT DIRECTOR)
Entity Organization
Organization subpart 1 Yes
Enumeration date 06/16/2005
Last updated 08/07/2024 - More than a year ago
Identifiers
KY License # 100490
KY Medicaid 12400024
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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