Organization
GRAYSON COUNTY HOSPITAL FOUNDATION INC.
Active
Other names
Twin Lakes Home Health Agency
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MONA GAIL FULKERSON RN (DIRECTOR OF HOME HEALTH)
(270) 259-9525
Entity
Organization
Contact information
Practice address
910 WALLACE AVE, LEITCHFIELD, KY 42754-1418
(270) 259-9525
(270) 259-1670
Mailing address
910 WALLACE AVE, LEITCHFIELD, KY 42754-1418
(270) 259-9525
(270) 259-1670
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
150102
KY
251X00000X
Supports Brokerage Agency
150102
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000054567
ANTHEM
KY
05
—
1050335
—
KY
01
—
2432817000
PASSPORT ADVANTAGE
KY
05
—
34001446
—
KY
05
—
42001438
—
KY
Enumeration date
07/15/2005
Last updated
06/25/2008
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