Provider Demographics
NPI:1598763898
Name:WELLINGTON PARC HEALTH SYSTEMS, INC.
Entity Type:Organization
Organization Name:WELLINGTON PARC HEALTH SYSTEMS, INC.
Other - Org Name:WELLINGTON PARC OF OWENSBORO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SKAGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-926-9355
Mailing Address - Street 1:725 HARVARD DR
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-6185
Mailing Address - Country:US
Mailing Address - Phone:270-926-9355
Mailing Address - Fax:270-684-6283
Practice Address - Street 1:2885 NEW HARTFORD RD
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1320
Practice Address - Country:US
Practice Address - Phone:270-685-2374
Practice Address - Fax:270-926-8510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-11
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100648314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY12503355Medicaid
KY185436Medicare Oscar/Certification