Provider Demographics
NPI:1326190323
Name:PACER HEALTH MANAGEMENT CORPORATION OF KENTUCKY
Entity Type:Organization
Organization Name:PACER HEALTH MANAGEMENT CORPORATION OF KENTUCKY
Other - Org Name:KNOX COUNTY HOSPITAL SNF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-545-5521
Mailing Address - Street 1:80 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:BARBOURVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40906-7363
Mailing Address - Country:US
Mailing Address - Phone:606-545-5500
Mailing Address - Fax:606-545-5511
Practice Address - Street 1:80 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:BARBOURVILLE
Practice Address - State:KY
Practice Address - Zip Code:40906-7363
Practice Address - Country:US
Practice Address - Phone:606-545-5500
Practice Address - Fax:606-545-5511
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KNOX HOSPITAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-18
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100721314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY12504767Medicaid
KY12504767Medicaid