Organization
COMMONWEALTH OF KENTUCKY
Active
Parent organization
COMMONWEALTH OF KENTUCKY
Other names
Western State Nursing Facility
Organization subpart
Yes
Provider details
NPI number
Legal business name
COMMONWEALTH OF KENTUCKY
Authorized official
JENNIFER MOORE (ASSISTANT DIRECTOR)
(502) 782-6117
Entity
Organization
Contact information
Practice address
2400 RUSSELLVILLE RD, US 68 EAST, HOPKINSVILLE, KY 42241
(502) 886-4431
(270) 886-4487
Mailing address
PO BOX 2200, 2400 RUSSELLVILLE ROAD, US 68 EAST, HOPKINSVILLE, KY 42241
(502) 886-4431
(270) 886-4487
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
KY
313M00000X
Nursing Facility/Intermediate Care Facility
100490
KY
313M00000X
Nursing Facility/Intermediate Care Facility
—
KY
315P00000X
Intellectual Disabilities Intermediate Care Facility
—
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
12400024
—
KY
Enumeration date
06/16/2005
Last updated
08/07/2024
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