Provider Demographics
NPI:1588637425
Name:ROCKCASTLE COUNTY HOSPITAL, INC.
Entity type:Organization
Organization Name:ROCKCASTLE COUNTY HOSPITAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-256-2195
Mailing Address - Street 1:145 LEWIS ST
Mailing Address - Street 2:P O BOX 1186
Mailing Address - City:MOUNT VERNON
Mailing Address - State:KY
Mailing Address - Zip Code:40456-2761
Mailing Address - Country:US
Mailing Address - Phone:606-256-2195
Mailing Address - Fax:
Practice Address - Street 1:145 LEWIS ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:KY
Practice Address - Zip Code:40456-2761
Practice Address - Country:US
Practice Address - Phone:606-256-2195
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-10
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY150179251E00000X
252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY150179OtherSTATE ID
KY34000034Medicaid
KY000000203172OtherBLUE CROSS BLUE SHIELD
KY42000083OtherWAIVER
KY45002045OtherEPSDT
KYC-76OtherBLUE CROSS BLUE SHIELD
KY34000034Medicaid