Provider Demographics
NPI:1417951468
Name:MERCY HEALTH-LOURDES HOSPITAL LLC
Entity Type:Organization
Organization Name:MERCY HEALTH-LOURDES HOSPITAL LLC
Other - Org Name:LOURDES - REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGION CEO & SVP KY
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:YUNGMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-444-2491
Mailing Address - Street 1:PO BOX 636545
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6545
Mailing Address - Country:US
Mailing Address - Phone:270-444-2444
Mailing Address - Fax:270-444-2460
Practice Address - Street 1:1530 LONE OAK RD
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-7901
Practice Address - Country:US
Practice Address - Phone:270-444-2444
Practice Address - Fax:270-444-2460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-08
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY93000016Medicaid
KY18T102Medicare Oscar/Certification