Provider Demographics
NPI:1053489930
Name:OWSLEY COUNTY HEALTH CARE CENTER, INC.
Entity Type:Organization
Organization Name:OWSLEY COUNTY HEALTH CARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-593-6302
Mailing Address - Street 1:HIGHWAY 11
Mailing Address - Street 2:P O BOX 250
Mailing Address - City:BOONEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41314
Mailing Address - Country:US
Mailing Address - Phone:606-593-6302
Mailing Address - Fax:606-593-6078
Practice Address - Street 1:HIGHWAY 11
Practice Address - Street 2:
Practice Address - City:BOONEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41314
Practice Address - Country:US
Practice Address - Phone:606-593-6302
Practice Address - Fax:606-593-6078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100526314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY12501631Medicaid
KY066773OtherKY TAX ID NUMBER
KY003606092OtherKY UNEMPLOYMENT INSURANCE
KY0931170001Medicare NSC
KY066773OtherKY TAX ID NUMBER