Organization
COMMUNTIY HEALTHCARE OF WESTERN KENTUCKY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. STEPHANNIE LORENE GOODRUM RN (OWNER)
(270) 653-0220
Entity
Organization
Contact information
Practice address
308 SOUTH WASHINGTON STREET SUITE 200, CLINTON, KY 42031
(270) 653-0220
(270) 653-0221
Mailing address
308 SOUTH WASHINGTON STREET SUITE 200, CLINTON, KY 42031-1347
(270) 653-0220
(270) 653-0221
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1760722144
NPI
KY
05
—
7100237310
—
KY
Enumeration date
09/04/2017
Last updated
07/21/2022
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