Provider Demographics
NPI:1609586122
Name:OHANA CARE OF LAKE CUMBERLAND, LLC
Entity Type:Organization
Organization Name:OHANA CARE OF LAKE CUMBERLAND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARA
Authorized Official - Middle Name:B
Authorized Official - Last Name:PENCE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:606-305-0928
Mailing Address - Street 1:650 S HIGHWAY 27 # 308
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42501-3501
Mailing Address - Country:US
Mailing Address - Phone:606-305-0928
Mailing Address - Fax:
Practice Address - Street 1:100 HARDIN LN STE 3 1/2
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-3812
Practice Address - Country:US
Practice Address - Phone:606-305-0928
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1386051068OtherNPI INDIVIDUAL