Organization
PENNYROYAL HEALTHCARE SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KECIA FULCHER (CEO/DIRECTOR)
(270) 886-2205
Entity
Organization
Contact information
Practice address
1102 S VIRGINIA ST, HOPKINSVILLE, KY 42240-3579
(270) 365-0227
(270) 365-2559
Mailing address
310 HAWTHORNE ST, PRINCETON, KY 42445-1622
(270) 365-0227
(270) 365-2559
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100200060
—
KY
Enumeration date
04/27/2011
Last updated
03/16/2018
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