Organization
COMMONWEALTH OF KENTUCKY
Active
Parent organization
COMMONWEALTH OF KENTUCKY
Other names
Oakwood Specialty Intermediate Care Clinic
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
2441 US HIGHWAY 27, SOMERSET, KY 42501
(606) 677-4068
(606) 677-4148
Mailing address
2441 US HIGHWAY 27, SOMERSET, KY 42501
(606) 677-4068
(606) 677-4148
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
KY
261QM1300X
Multi-Specialty Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100284200
—
KY
01
—
740294
CHFS LICENSE NUMBER
KY
Enumeration date
03/20/2014
Last updated
08/07/2024
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