Provider Demographics
NPI:1104828383
Name:BRECKINRIDGE HEALTH, INC
Entity Type:Organization
Organization Name:BRECKINRIDGE HEALTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:PORTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-756-6569
Mailing Address - Street 1:1011 OLD HIGHWAY 60
Mailing Address - Street 2:
Mailing Address - City:HARDINSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40143-2519
Mailing Address - Country:US
Mailing Address - Phone:270-756-6569
Mailing Address - Fax:270-580-2208
Practice Address - Street 1:1011 OLD HIGHWAY 60
Practice Address - Street 2:
Practice Address - City:HARDINSBURG
Practice Address - State:KY
Practice Address - Zip Code:40143-2519
Practice Address - Country:US
Practice Address - Phone:270-756-7000
Practice Address - Fax:270-580-2208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY600070282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1041597OtherPASSPORT
KY185285OtherSNF
KY12503173Medicaid
KY000000054573OtherBLUE CROSS
KY000000069148OtherBLUE SHIELD
KY01015932Medicaid
KY18Z319OtherMEDICARE SWING BED
KY1041597OtherPASSPORT