Provider Demographics
NPI:1518962356
Name:KENTUCKY CORRECTIONAL PSYCHIATRIC CENTER
Entity Type:Organization
Organization Name:KENTUCKY CORRECTIONAL PSYCHIATRIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE SUPERINTENDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:W
Authorized Official - Last Name:PROCTOR
Authorized Official - Suffix:
Authorized Official - Credentials:RHIA
Authorized Official - Phone:502-222-7163
Mailing Address - Street 1:1612 DAWKINS RD
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40031-8729
Mailing Address - Country:US
Mailing Address - Phone:502-222-7161
Mailing Address - Fax:502-222-7798
Practice Address - Street 1:1612 DAWKINS RD
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-8729
Practice Address - Country:US
Practice Address - Phone:502-222-7161
Practice Address - Fax:502-222-7798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100528283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital