Provider Demographics
NPI:1003892753
Name:LIVINGSTON HOSPITAL AND HEALTHCARE SERVICES, INC. CAH
Entity Type:Organization
Organization Name:LIVINGSTON HOSPITAL AND HEALTHCARE SERVICES, INC. CAH
Other - Org Name:LIVINGSTON HOSPITAL HOME HEALTH AGENCY
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BUDNICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-988-2299
Mailing Address - Street 1:131 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:KY
Mailing Address - Zip Code:42078-8043
Mailing Address - Country:US
Mailing Address - Phone:270-988-2299
Mailing Address - Fax:270-988-3900
Practice Address - Street 1:131 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:KY
Practice Address - Zip Code:42078-8043
Practice Address - Country:US
Practice Address - Phone:270-988-2299
Practice Address - Fax:270-988-3900
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIVINGSTON HOSPITAL AND HEALTHCARE SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-12-15
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY150143251E00000X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY42001792Medicaid
KY34001701Medicaid
KY34001701Medicaid