Organization
COMMONWEALTH OF KENTUCKY
Active
Parent organization
COMMONWEALTH OF KENTUCKY
Other names
Outwood ICF
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
23524 DAWSON SPRINGS RD, DAWSON SPRINGS, KY 42408-9205
(270) 797-3771
(270) 797-3592
Mailing address
9901 LINN STATION RD, LOUISVILLE, KY 40223-3808
(800) 866-0860
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
100458
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
119021111
—
KY
Enumeration date
02/01/2007
Last updated
08/07/2024
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