Basic Information
| Provider Information | |||||||||
| NPI: | 1154303113 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BARREN COUNTY HEALTH CARE CENTER | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 300 WESTWOOD ST | ||||||||
| Address2: | |||||||||
| City: | GLASGOW | ||||||||
| State: | KY | ||||||||
| PostalCode: | 42141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2706519131 | ||||||||
| FaxNumber: | 2706516989 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 WESTWOOD ST | ||||||||
| Address2: | |||||||||
| City: | GLASGOW | ||||||||
| State: | KY | ||||||||
| PostalCode: | 42141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2706519131 | ||||||||
| FaxNumber: | 2706516989 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2005 | ||||||||
| LastUpdateDate: | 04/16/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BROWN | ||||||||
| AuthorizedOfficialFirstName: | FREDERICK | ||||||||
| AuthorizedOfficialMiddleName: | STEVE | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2706519131 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | NURSING HOME ADMINIS | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 100509 | KY | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 12500450 | 05 | KY | MEDICAID |