Organization
ROCKCASTLE COUNTY HOSPITAL, INC.
Active
Other names
Rockcastle Hospital Home Health
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES BLACK (CFO)
(606) 256-2195
Entity
Organization
Contact information
Practice address
145 LEWIS ST, MOUNT VERNON, KY 40456-2761
(606) 256-2195
Mailing address
145 LEWIS ST, P O BOX 1186, MOUNT VERNON, KY 40456-2761
(606) 256-2195
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
150179
KY
252Y00000X
Early Intervention Provider Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000203172
BLUE CROSS BLUE SHIELD
KY
01
—
150179
STATE ID
KY
05
—
34000034
—
KY
01
—
42000083
WAIVER
KY
01
—
45002045
EPSDT
KY
01
—
C-76
BLUE CROSS BLUE SHIELD
KY
Enumeration date
02/10/2006
Last updated
03/29/2010
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