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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