Basic Information
| Provider Information | |||||||||
| NPI: | 1336205897 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARSHALL COUNTY HOSPITAL LONG TERM CARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 503 GEORGE MCCLAIN DR | ||||||||
| Address2: | |||||||||
| City: | BENTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420251331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2705274800 | ||||||||
| FaxNumber: | 2705274853 | ||||||||
| Practice Location | |||||||||
| Address1: | 503 GEORGE MCCLAIN DR | ||||||||
| Address2: | |||||||||
| City: | BENTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420251331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2705274800 | ||||||||
| FaxNumber: | 2705274853 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | LONG | ||||||||
| AuthorizedOfficialFirstName: | KATHY | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 2705274800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 313M00000X | 100328 | KY | Y | Nursing & Custodial Care Facilities | Nursing Facility/Intermediate Care Facility |
ID Information
| ID | Type | State | Issuer | Description | 000000054609 | 01 | KY | BLUE CROSS | OTHER | 12501979 | 05 | KY | MEDICAID |