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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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