Organization
COMMONWEALTH OF KENTUCKY
Active
Parent organization
COMMONWEALTH OF KENTUCKY
Other names
Western State Hospital
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, HOPKINSVILLE, KY 42240-8095
(270) 889-6025
(270) 886-4487
Mailing address
2440 RUSSELLVILLE ROAD, HOPKINSVILLE, KY 42240
(270) 889-6025
(270) 886-4487
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
—
—
283Q00000X
Psychiatric Hospital
100072
KY
283Q00000X
Psychiatric Hospital
Primary
—
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02020022
—
KY
05
—
65944852
—
KY
Enumeration date
06/16/2005
Last updated
08/07/2024
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