Organization
COMMONWEALTH OF KENTUCKY
Active
Parent organization
COMMONWEALTH OF KENTUCKY
Other names
Central State Hospital Physicians
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) 253-7090
Mailing address
10510 LAGRANGE ROAD, LOUISVILLE, KY 40223
(502) 253-7000
(503) 253-7090
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
KY
2084P0800X
Psychiatry Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
65945396
—
KY
Enumeration date
04/28/2011
Last updated
10/30/2024
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