Organization
LIVINGSTON HOSPITAL AND HEALTHCARE SERVICES, INC.
Active
Organization
LIVINGSTON HOSPITAL AND HEALTHCARE SERVICES, INC.
Active
Other names
Grand Lakes Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK A EDWARDS (CHIEF EXECUTIVE OFFICER)
(270) 988-2299
Entity
Organization
Contact information
Practice address
1860 JH OBRYAN AVE, GRAND RIVERS, KY 42045-9049
(703) 628-2462
(270) 362-9757
Mailing address
131 HOSPITAL DR, SALEM, KY 42078-8043
(270) 988-2299
(270) 988-3900
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
9000135
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000072411
BC/BS
KY
05
—
3500140300
—
KY
Enumeration date
12/16/2005
Last updated
11/02/2020
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