Organization
COMMONWEALTH OF KENTUCKY
Active
Organization
COMMONWEALTH OF KENTUCKY
Active
Parent organization
COMMONWEALTH OF KENTUCKY
Other names
Central 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
10510 LAGRANGE ROAD, LOUISVILLE, KY 40223
(502) 253-7000
(503) 253-7044
Mailing address
10510 LAGRANGE ROAD, LOUISVILLE, KY 40223
(502) 253-7000
(503) 253-7044
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
—
—
208D00000X
General Practice Physician
—
—
283Q00000X
Psychiatric Hospital
Primary
—
KY
283Q00000X
Psychiatric Hospital
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02021293
—
KY
Enumeration date
09/23/2010
Last updated
10/30/2024
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